Compositions for the treatment of hypertension

ABSTRACT

Provided herein are pharmaceutical compositions that are useful for the treatment of hypertension comprising an angiotensin II receptor blocker, a diuretic, and a calcium channel blocker.

CROSS REFERENCE

This application is a continuation of U.S. application Ser. No.16/393,774, filed Apr. 24, 2019, which is a continuation of U.S.application Ser. No. 15/919,923, filed Mar. 13, 2018, now U.S. Pat. No.10,322,117, issued Jun. 18, 2019, which is a continuation ofInternational Application No. PCT/IB2018/000083, filed Jan. 23, 2018,which claims the benefit of U.S. Provisional Application No. 62/450,324,filed Jan. 25, 2017, each of which are hereby incorporated by referencein their entirety.

BACKGROUND OF THE DISCLOSURE

High blood pressure, also known as hypertension, is a leading cause ofpreventable morbidity and mortality and it is well established thattreatments that lower blood pressure (BP) are beneficial. However,despite the plethora of blood pressure lowering medicines available,many patients continue to have poor blood pressure control as evidencedby multiple large-scale population studies. Contributing factors forpoor blood pressure control include poor adherence, complex guidelinesrecommending multiple up-titration steps, and treatment inertia.Furthermore, the majority of treated patients receive only monotherapy,which has limited potency even at high doses where side effects areincreased and tolerability reduced. Accordingly, there exists a need fornew treatments for lowering high blood pressure that are efficacious andtolerable.

SUMMARY OF THE DISCLOSURE

Provided herein in one aspect is a pharmaceutical composition comprising

-   -   (a) an angiotensin II receptor blocker;    -   (b) a diuretic; and    -   (c) a calcium channel blocker        wherein the dose of each (a), (b), and (c) is from about 40% to        about 80% of the lowest hypertension therapeutic dose (LHTD) for        each of the (a), (b), and (c).

In some embodiments, the pharmaceutical composition is essentially freeof an angiotensin-converting enzyme inhibitor or a pharmaceuticallyacceptable salt thereof, a beta-blocker or a pharmaceutically acceptablesalt thereof, a lipid-regulating agent, platelet function-alteringagent, a serum homocysteine-lowering agent, or a combination thereof.

In some embodiments, the diuretic is a thiazide-like diuretic. In someembodiments, the thiazide-like diuretic is quinethazone, clopamide,chlorthalidone, mefruside, clofenamide, metolazone, meticrane, xipamide,indapamide, clorexolone, fenquizone, or the pharmaceutically acceptablesalt or hydrate thereof. In some embodiments, the thiazide-like diureticis indapamide or the hydrate thereof. In some embodiments, thethiazide-like diuretic is indapamide.

In some embodiments, the calcium channel blocker is amlodipine,nifedipine, diltiazem, nimodipine, verapamil, isradipine, felodipine,nicardipine, nisoldipine, clevidipine, dihydropyridine, lercanidipine,nitrendipine, cilnidipine, manidipine, mibefradil, bepridil,barnidipine, nilvadipine, gallopamil, lidoflazine, aranidipine,dotarizine, diproteverine, or the pharmaceutically acceptable salt orhydrate thereof. In some embodiments, the calcium channel blocker isamlodipine or the pharmaceutically acceptable salt thereof. In someembodiments, the calcium channel blocker is amlodipine besylate.

In some embodiments, the angiotensin II receptor blocker is irbesartan,telmisartan, valsartan, candesartan, eprosartan, olmesartan, azilsartan,losartan, or the pharmaceutically acceptable salt or hydrate thereof. Insome embodiments, the angiotensin II receptor blocker is telmisartan.

In some embodiments, the dose of each (a), (b), and (c) is from about40% to about 60% of the lowest hypertension therapeutic dose (LHTD) foreach of the (a), (b), and (c). In some embodiments, the diuretic is athiazide-like diuretic, and the dose of the thiazide-like diuretic isabout 50% of the lowest hypertension therapeutic dose (LHTD) for thethiazide-like diuretic. In some embodiments, the thiazide-like diureticis indapamide, and the dose of the indapamide is about 0.625 mg. In someembodiments, the dose of the calcium channel blocker is about 50% of thelowest hypertension therapeutic dose (LHTD) for the calcium channelblocker. In some embodiments, the calcium channel blocker is amlodipinebesylate, and the dose of amlodipine besylate is about 1.25 mg. In someembodiments, the dose of the angiotensin II receptor blocker is about50% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker. In some embodiments, the angiotensin IIreceptor blocker is telmisartan, and the dose of the telmisartan isabout 10 mg. In some embodiments, the angiotensin II receptor blocker istelmisartan, the diuretic is indapamide, and the calcium channel blockeris amlodipine besylate. In some embodiments, the dose of telmisartan isfrom about 8 mg to about 12 mg, the dose of indapamide is from about 0.5mg to about 0.75 mg, and the dose of amlodipine besylate is from about 1mg to about 1.5 mg. In some embodiments, the dose of telmisartan isabout 10 mg, the dose of indapamide is about 0.625 mg, and the dose ofamlodipine besylate is about 1.25 mg.

Provided in another aspect is a pharmaceutical composition comprising

-   -   (a) telmisartan;    -   (b) a thiazide-like diuretic; and    -   (c) a calcium channel blocker        wherein the dose of each (a), (b), and (c) is from about 80% to        about 150% of the lowest hypertension therapeutic dose (LHTD)        for each of the (a), (b), and (c).

In some embodiments, the pharmaceutical composition is essentially freeof an angiotensin-converting enzyme inhibitor or a pharmaceuticallyacceptable salt thereof, a beta-blocker or a pharmaceutically acceptablesalt thereof, a lipid-regulating agent, platelet function-alteringagent, a serum homocysteine-lowering agent, or a combination thereof.

In some embodiments, the thiazide-like diuretic is quinethazone,clopamide, chlorthalidone, mefruside, clofenamide, metolazone,meticrane, xipamide, indapamide, clorexolone, fenquizone, or thepharmaceutically acceptable salt or hydrate thereof. In someembodiments, the thiazide-like diuretic is indapamide or the hydratethereof. In some embodiments, the thiazide-like diuretic is indapamide.

In some embodiments, the calcium channel blocker is amlodipine,nifedipine, diltiazem, nimodipine, verapamil, isradipine, felodipine,nicardipine, nisoldipine, clevidipine, dihydropyridine, lercanidipine,nitrendipine, cilnidipine, manidipine, mibefradil, bepridil,barnidipine, nilvadipine, gallopamil, lidoflazine, aranidipine,dotarizine, diproteverine, or the pharmaceutically acceptable salt orhydrate thereof. In some embodiments, the calcium channel blocker isamlodipine or the pharmaceutically acceptable salt thereof. In someembodiments, the calcium channel blocker is amlodipine besylate.

In some embodiments, the dose of each (a), (b), and (c) is from about80% to about 120% of the lowest hypertension therapeutic dose (LHTD) foreach of the (a), (b), and (c). In some embodiments, the dose of thethiazide-like diuretic is about 100% of the lowest hypertensiontherapeutic dose (LHTD) for the thiazide-like diuretic. In someembodiments, the thiazide-like diuretic is indapamide, and the dose ofthe indapamide is about 1.25 mg. In some embodiments, the dose of thecalcium channel blocker is about 100% of the lowest hypertensiontherapeutic dose (LHTD) for the calcium channel blocker. In someembodiments, the calcium channel blocker is amlodipine besylate, and thedose of amlodipine besylate is about 2.5 mg. In some embodiments, thedose of the telmisartan is about 100% of the lowest hypertensiontherapeutic dose (LHTD) for telmisartan. In some embodiments, the doseof the telmisartan is about 20 mg. In some embodiments, thethiazide-like diuretic is indapamide, and the calcium channel blocker isamlodipine besylate. In some embodiments, the dose of telmisartan isfrom about 16 mg to about 24 mg, the dose of indapamide is from about 1mg to about 1.5 mg, and the dose of amlodipine besylate is from about 2mg to about 3 mg. In some embodiments, the dose of telmisartan is about20 mg, the dose of indapamide is about 1.25 mg, and the dose ofamlodipine besylate is about 2.5 mg.

In some embodiments for the pharmaceutical compositions disclosedherein, (a), (b), and (c) are provided in one formulation. In someembodiments, (a), (b), and (c) are each provided in a separateformulation. In some embodiments, two of the (a), (b), and (c) areprovided in one formulation. In some embodiments, the pharmaceuticalcomposition is in the form of pill, tablet, or capsule. In someembodiments, the pharmaceutical composition is suitable for oraladministration.

Also provided herein is a method of treating hypertension in a subjectin need thereof comprising administering any one of the pharmaceuticalcompositions disclosed herein. In some embodiments, the treatmentresults in a systolic blood pressure (SBP) of less than about 140 mmHg.In some embodiments, the treatment results in a reduction of systolicblood pressure (SBP) of about 10 mmHg or greater. In some embodiments,the treatment results in a diastolic blood pressure (DBP) of less thanabout 90 mmHg. In some embodiments, the treatment results in a reductionof diastolic blood pressure (DBP) of about 5 mmHg or greater. In someembodiments, the treatment results in a reduction in systolic bloodpressure (SBP) that is greater than the reduction obtained with the fulllowest hypertension therapeutic dose of any one of the (a), (b), and (c)in the pharmaceutical composition. In some embodiments, the treatmentresults in a reduction in diastolic blood pressure (DBP) that is greaterthan the reduction obtained with the full lowest hypertensiontherapeutic dose of any one of (a), (b), and (c) in the pharmaceuticalcomposition. In some embodiments, the treatment results in greater longterm tolerability and reduced risk of side effects when compared totreatment with the full lowest hypertension therapeutic dose of any oneof (a), (b), and (c) in the pharmaceutical composition. In someembodiments, the treatment is the initial or first-line treatment ofhypertension. In some embodiments, the subject is not receiving anyprevious hypertension therapy prior to treatment.

Provided herein in another aspect is a pharmaceutical compositionconsisting essentially of

-   -   (a) an angiotensin II receptor blocker    -   (b) a diuretic; and    -   (c) a calcium channel blocker        wherein the dose of each (a), (b), and (c) is from about 40% to        about 80% of the lowest hypertension therapeutic dose (LHTD) for        each of the (a), (b), and (c).

Provided herein in another aspect is a pharmaceutical compositionconsisting essentially of

-   -   (a) an angiotensin II receptor blocker, such as telmisartan;    -   (b) a thiazide-like diuretic; and    -   (c) a calcium channel blocker        wherein the dose of each (a), (b), and (c) is from about 80% to        about 150% of the lowest hypertension therapeutic dose (LHTD)        for each of the (a), (b), and (c). In some embodiments, the dose        of each (a), (b), and (c) is from about 80% to about 120% of the        lowest hypertension therapeutic dose (LHTD) for each of the (a),        (b), and (c). In some embodiments, the dose of each (a), (b),        and (c) is from about 90% to about 110% of the lowest        hypertension therapeutic dose (LHTD) for each of the (a), (b),        and (c).

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the disclosure are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present disclosure will be obtained by reference tothe following detailed description that sets forth illustrativeembodiments, in which the principles of the disclosure are utilized, andthe accompanying drawings of which:

FIG. 1 shows the mean systolic blood pressure (mmHg) across time periodsby treatment.

FIG. 2 shows the mean diastolic blood pressure (mmHg) across timeperiods by treatment.

FIG. 3 shows the mean heart rate across time periods by treatment.

DETAILED DESCRIPTION OF THE DISCLOSURE

Provided herein are pharmaceutical compositions for the treatment ofhypertension comprising an angiotensin II receptor blocker, a diuretic,and a calcium channel blocker. In some embodiments, the dose of eachcomponent is below the lowest dose approved for the treatment ofhypertension. The present disclosure recognizes the technical effects oflow-dose combination therapy set forth herein, including but not limitedto, the use of low-doses to avoid or ameliorate side effects whileretaining or improving benefits, the synergistic therapeutic benefits ofcertain drug combinations, the early introduction of combination therapyto improve therapeutic effects, etc. Described herein in one aspect arelow-dose combination compositions for the treatment of hypertension,including the initial or first-line treatment of hypertension.

Certain Terminology

As used herein and in the appended claims, the singular forms “a,”“and,” and “the” include plural referents unless the context clearlydictates otherwise. Thus, for example, reference to “an agent” includesa plurality of such agents, and reference to “the composition” includesreference to one or more compositions (or to a plurality ofcompositions) and equivalents thereof known to those skilled in the art,and so forth. When ranges are used herein for physical properties, suchas molecular weight, or chemical properties, such as chemical formulae,all combinations and subcombinations of ranges and specific embodimentstherein are intended to be included. The term “about” when referring toa number or a numerical range means that the number or numerical rangereferred to is an approximation within experimental variability (orwithin statistical experimental error), and thus in some embodiments,the number or numerical range varies between 1% and 10% of the statednumber or numerical range. The term “comprising” (and related terms suchas “comprise” or “comprises” or “having” or “including”) is not intendedto exclude that in other certain embodiments, for example, an embodimentof any composition of matter, composition, method, or process, or thelike, described herein, may “consist of” or “consist essentially of” thedescribed features.

Definitions

As used in the specification and appended claims, unless specified tothe contrary, the following terms have the meaning indicated below.

“Pharmaceutically acceptable salt” as used herein includes both acid andbase addition salts. In some embodiments, the pharmaceuticallyacceptable salt of any one of the compounds described herein is the formapproved for use by the US Food and Drug Administration. Preferredpharmaceutically acceptable salts of the compounds described herein arepharmaceutically acceptable acid addition salts and pharmaceuticallyacceptable base addition salts.

“Pharmaceutically acceptable acid addition salt” refers to those saltswhich retain the biological effectiveness and properties of the freebases, which are not biologically or otherwise undesirable, and whichare formed with inorganic acids such as hydrochloric acid, hydrobromicacid, sulfuric acid, nitric acid, phosphoric acid, hydroiodic acid,hydrofluoric acid, phosphorous acid, and the like. Also included aresalts that are formed with organic acids such as aliphatic mono- anddicatboxylic acids, phenyl-substituted alkanoic acids, hydroxy alkanoicacids, alkanedioic acids, aromatic acids, aliphatic and aromaticsulfonic acids, etc. and include, for example, acetic acid,trifluoroacetic acid, propionic acid, glycolic acid, pyruvic acid,oxalic acid, maleic acid, malonic acid, succinic acid, fumaric acid,tartaric acid, citric acid, benzoic acid, cinnamic acid, mandelic acid,methanesulfonic acid, ethanesulfonic acid, p-toluenesulfonic acid,salicylic acid, and the like. Exemplary salts thus include sulfates,pyrosulfates, bisulfates, sulfites, bisulfites, nitrates, phosphates,monohydrogenphosphates, dihydrogenphosphates, metaphosphates,pyrophosphates, chlorides, bromides, iodides, acetates,trifluoroacetates, propionates, caprylates, isobutyrates, oxalates,malonates, succinate suberates, sebacates, fumarates, maleates,mandelates, benzoates, chlorobenzoates, methylbenzoates,dinitrobenzoates, phthalates, benzenesulfonates, toluenesulfonates,phenylacetates, citrates, lactates, malates, tartrates,methanesulfonates, and the like. Also contemplated are salts of aminoacids, such as arginates, gluconates, and galacturonates (see, forexample, Berge S. M. et al., “Pharmaceutical Salts,” Journal ofPharmaceutical Science, 66:1-19 (1997), which is hereby incorporated byreference in its entirety). Acid addition salts of basic compounds maybe prepared by contacting the free base forms with a sufficient amountof the desired acid to produce the salt according to methods andtechniques with which a skilled artisan is familiar.

“Pharmaceutically acceptable base addition salt” refers to those saltsthat retain the biological effectiveness and properties of the freeacids, which are not biologically or otherwise undesirable. These saltsare prepared from addition of an inorganic base or an organic base tothe free acid. Pharmaceutically acceptable base addition salts may beformed with metals or amines, such as alkali and alkaline earth metalsor organic amines. Salts derived from inorganic bases include, but arenot limited to, sodium, potassium, lithium, ammonium, calcium,magnesium, iron, zinc, copper, manganese, aluminum salts and the like.Salts derived from organic bases include, but are not limited to, saltsof primary, secondary, and tertiary amines, substituted amines includingnaturally occurring substituted amines, cyclic amines and basic ionexchange resins, for example, isopropylamine, trimethylamine,diethylamine, triethylamine, tripropylamine, ethanolamine,diethanolamine, 2-dimethylaminoethanol, 2-diethylaminoethanol,dicyclohexylamine, lysine, arginine, histidine, caffeine, procaine,N,N-dibenzylethylenediamine, chloroprocaine, hydrabamine, choline,betaine, ethylenediamine, ethylenedianiline, N-methylglucamine,glucosamine, methylglucamine, theobromine, purines, piperazine,piperidine, N-ethylpiperidine, polyamine resins and the like. See Bergeet al., supra.

As used herein, “hydrates” are compounds that contain eitherstoichiometric or non-stoichiometric amounts of water, and, in someembodiments, are formed during the process of crystallization withwater. Hydrates are meant to include the hydrates of any one of thecompounds described herein that is approved for use by the US Food andDrug Administration.

The term “acceptable” with respect to a formulation, composition oringredient, as used herein, means having no persistent detrimentaleffect on the general health of the subject being treated.

The terms “administer,” “administering,” “administration,” and the like,as used herein, refer to the methods that may be used to enable deliveryof compounds or compositions to the desired site of biological action.These methods include, but are not limited to, oral routes,intraduodenal routes, parenteral injection (including intravenous,subcutaneous, intraperitoneal, intramuscular, intravascular orinfusion), topical, and rectal administration. Those of skill in the artare familiar with administration techniques that can be employed withthe compounds and methods described herein. In some embodiments, thecompounds and compositions described herein are administered orally.

The term “subject” or “patient” encompasses mammals. Examples of mammalsinclude, but are not limited to, any member of the Mammalian class:humans, non-human primates such as chimpanzees, and other apes andmonkey species; farm animals such as cattle, horses, sheep, goats,swine; domestic animals such as rabbits, dogs, and cats; laboratoryanimals including rodents, such as rats, mice and guinea pigs, and thelike. In one aspect, the mammal is a human.

As used herein, “treatment” or “treating” or “palliating” or“ameliorating” are used interchangeably herein. These terms refers to anapproach for obtaining beneficial or desired results including but notlimited to therapeutic benefit and/or a prophylactic benefit. By“therapeutic benefit” is meant eradication or amelioration of theunderlying disorder being treated. Also, a therapeutic benefit isachieved with the eradication or amelioration of one or more of thephysiological symptoms associated with the underlying disorder such thatan improvement is observed in the patient, notwithstanding that thepatient may still be afflicted with the underlying disorder. Forprophylactic benefit, the compositions may be administered to a patientat risk of developing a particular disease, or to a patient reportingone or more of the physiological symptoms of a disease, even though adiagnosis of this disease may not have been made.

Triple Compositions

Described herein are pharmaceutical compositions comprising (a) anangiotensin II receptor blocker; (b) a diuretic; and (c) a calciumchannel blocker; wherein the dose of each (a), (b), and (c) is fromabout 40% to about 80% of the lowest hypertension therapeutic dose(LHTD) for each of the (a), (b), and (c). In some embodiments, the doseof each (a), (b), and (c) is about 40% to about 60% of the lowesthypertension therapeutic dose (LHTD) for each of the (a), (b), and (c).In some embodiments, the dose of each (a), (b), and (c) is about 50% ofthe lowest hypertension therapeutic dose (LHTD) for each of the (a),(b), and (c). In some embodiments, the dose of each (a), (b), and (c) isabout 60% to about 80% of the lowest hypertension therapeutic dose(LHTD) for each of the (a), (b), and (c). In some embodiments, the doseof each (a), (b), and (c) is about 66% of the lowest hypertensiontherapeutic dose (LHTD) for each of the (a), (b), and (c).

In some embodiments, the pharmaceutical composition comprises a bloodpressure-lowering combination of blood pressure-lowering active agents,wherein the blood pressure-lowering active agents consists of anangiotensin II receptor blocker, a diuretic, and a calcium channelblocker.

In another aspect described herein are pharmaceutical compositionscomprising (a) an angiotensin II receptor blocker, such as telmisartan;(b) a thiazide-like diuretic; and (c) a calcium channel blocker; whereinthe dose of each (a), (b), and (c) is from about 80% to about 150% ofthe lowest hypertension therapeutic dose (LHTD) for each of the (a),(b), and (c). In some embodiments, the dose of each (a), (b), and (c) isabout 80% to about 120% of the lowest hypertension therapeutic dose(LHTD) for each of the (a), (b), and (c). In some embodiments, the doseof each (a), (b), and (c) is about 90% to about 110% of the lowesthypertension therapeutic dose (LHTD) for each of the (a), (b), and (c).In some embodiments, the dose of each (a), (b), and (c) is about 95% toabout 105% of the lowest hypertension therapeutic dose (LHTD) for eachof the (a), (b), and (c). In some embodiments, the dose of each (a),(b), and (c) is about 100% of the lowest hypertension therapeutic dose(LHTD) for each of the (a), (b), and (c).

In some embodiments, the pharmaceutical compositions disclosed hereinare essentially free of an angiotensin-converting enzyme inhibitor (ACEinhibitor) or the pharmaceutically acceptable salt thereof. In someembodiments, the angiotensin-converting enzyme inhibitor includes, butis not limited to, benazepril, captopril, enalapril, fosinopril,lsinopril, moexipril, perindopril, quinapril, ramipril, trandolapril orthe pharmaceutically acceptable salt or hydrate thereof.

Also, described herein are pharmaceutical compositions consistingessentially (a) an angiotensin II receptor blocker; (b) a diuretic; and(c) a calcium channel blocker; wherein the dose of each (a), (b), and(c) is from about 40% to about 80% of the lowest hypertensiontherapeutic dose (LHTD) for each of the (a), (b), and (c). In someembodiments, the dose of each (a), (b), and (c) is about 40% to about60% of the lowest hypertension therapeutic dose (LHTD) for each of the(a), (b), and (c). In some embodiments, the dose of each (a), (b), and(c) is about 50% of the lowest hypertension therapeutic dose (LHTD) foreach of the (a), (b), and (c). In some embodiments, the dose of each(a), (b), and (c) is about 60% to about 80% of the lowest hypertensiontherapeutic dose (LHTD) for each of the (a), (b), and (c). In someembodiments, the dose of each (a), (b), and (c) is about 66% of thelowest hypertension therapeutic dose (LHTD) for each of the (a), (b),and (c).

Also, described herein are pharmaceutical compositions consistingessentially (a) an angiotensin II receptor blocker, such as telmisartan;(b) a thiazide-like diuretic; and (c) a calcium channel blocker; whereinthe dose of each (a), (b), and (c) is from about 80% to about 150% ofthe lowest hypertension therapeutic dose (LHTD) for each of the (a),(b), and (c). In some embodiments, the dose of each (a), (b), and (c) isabout 80% to about 120% of the lowest hypertension therapeutic dose(LHTD) for each of the (a), (b), and (c). In some embodiments, the doseof each (a), (b), and (c) is about 90% to about 110% of the lowesthypertension therapeutic dose (LHTD) for each of the (a), (b), and (c).In some embodiments, the dose of each (a), (b), and (c) is about 95% toabout 105% of the lowest hypertension therapeutic dose (LHTD) for eachof the (a), (b), and (c). In some embodiments, the dose of each (a),(b), and (c) is about 100% of the lowest hypertension therapeutic dose(LHTD) for each of the (a), (b), and (c).

In some embodiments, the pharmaceutical compositions disclosed hereinachieve a significant blood pressure reduction in a subject withmodestly elevated blood pressure. In some embodiments, thepharmaceutical compositions disclosed herein achieve a significant bloodpressure reduction in a subject with modestly elevated blood pressurewith minimum, insignificant or no side effects.

Beta-Blockers

In some embodiments, the pharmaceutical compositions disclosed hereinare essentially free of a beta blocker or the pharmaceuticallyacceptable salt thereof. In some embodiments, beta-blockers arecompounds that inhibit the receptor sites for the endogenouscatecholamines epinephrine (adrenaline) and norepinephrine(noradrenaline) on adrenergic beta receptors, of the sympathetic nervoussystem. In some embodiments, beta-blockers include, but are not limitedto, beta-adrenergic blocking agents, beta antagonists, beta-adrenergicantagonists, beta-adrenoreceptor antagonists, or beta adrenergicreceptor antagonists. In some embodiments, beta-blockers inhibitactivation of all types of β-adrenergic receptors. In some embodiments,beta-blockers inhibit both β-adrenergic receptors and α-adrenergicreceptors. In some embodiments, beta-blockers are selective for one offollowing beta receptors: β1, β2, and β3 receptors.

In some embodiments, the beta-blocker is a non-selectivebeta-adrenoceptor antagonist. Examples of non-selectivebeta-adrenoceptor antagonists include, but are not limited to, pindolol,propranolol, oxprenolol, sotalol, timolol, carteolol, penbutolol, andnadolol. In some embodiments, the beta-blocker is a compound withcombined β- and α-adrenoceptor blocking action. Suitable examplesinclude, but are not limited to, carvedilol, bucindolol and labetolol.In some embodiments, the beta-blocker is a β₁-selective adrenoceptorantagonist. Examples of β₁ selective adrenoceptor antagonist include,but are not limited to, atenolol, bisoprolol, betaxolol, metoprolol,celiprolol, esmolol, nebivolol, and acebutolol. In some embodiments, thebeta blocker is β₂-selective adrenoceptor antagonist, such asbutaxamine.

In some embodiments, the beta-blocker is acebutolol, atenolol,betaxolol, bisoprolol, carteolol, esmolol, penbutolol, metoprolol,nadolol, nebivolol, pindolol, sotalol, propranolol, carvedilol,labetalol, timolol, esmolol, celiprolol, oxprenolol, levobunolol,practolol, metipranolol, landiolol, bopindolol, pronethalol, butaxamine,bevantolol, tertatolol, arotinolol, levobetaxolol, befunolol,amosulalol, tilisolol, or the pharmaceutically acceptable salt orhydrate thereof. In some embodiments, the beta blocker is acebutolol,atenolol, betaxolol, bisoprolol, carteolol, esmolol, penbutolol,metoprolol, nadolol, nebivolol, pindolol, sotalol, propranolol,carvedilol, labetalol or the pharmaceutically acceptable salt or hydratethereof. In some embodiments, the beta blocker is acebutolol, atenolol,betaxolol, bisoprolol, celiprolol, oxprenolol, metoprolol, nadolol,nebivolol, pindolol, propranolol, carvedilol, labetalol, timolol, or thepharmaceutically acceptable salt or hydrate thereof. In someembodiments, the beta blocker is atenolol. In some embodiments, the betablocker is bisoprolol or the pharmaceutically acceptable salt.

Lipid-Regulating Agent

In some embodiments, the pharmaceutical compositions disclosed hereinare essentially free of a lipid-regulating agent, a plateletfunction-altering agent, a serum homocysteine-lowering agent, or acombination thereof.

In some embodiments, the pharmaceutical compositions disclosed hereinare essentially free of a lipid-regulating agent. In some embodiments,the lipid-regulating agent is a 3-hydroxy-3-methylglutaryl coenzyme A(HMG CoA) reductase inhibitor, also called a statin. In someembodiments, the lipid-regulating agent is atorvastatin, simvastatin,cerivastatin, fluvastatin, or pravastatin. In some embodiments, thelipid-regulating agent is atorvastatin or simvastatin. In someembodiments, the lipid-regulating agent is atorvastatin. In someembodiments, the lipid-regulating agent is simvastatin.

Platelet Function-Altering Agent

In some embodiments, the pharmaceutical compositions disclosed hereinare essentially free of a platelet function-altering agent. In someembodiments, the platelet function-altering agent is aspirin,ticlopidine, dipyridamole, clopidogrel. In some embodiments, theplatelet function-altering agent is a glycoprotein IIb/IIIa receptorinhibitor, such as abciximab. In some embodiments, the plateletfunction-altering agent is a non-steroidal anti-inflammatory drug, suchas ibuprofen. In some embodiments, the platelet function-altering agentis aspirin, ticlopidine, dipyridamole, clopidogrel, abciximab, oribuprofen. In some embodiments, the platelet function-altering agent isaspirin.

Serum Homocysteine-Lowering Agent

In some embodiments, the pharmaceutical compositions disclosed hereinare essentially free of a serum homocysteine-lowering agent. In someembodiments, the serum homocysteine-lowering agent is folic acid,vitamin B6, or vitamin B12, or a combination thereof. In someembodiments, the serum homocysteine-lowering agent is folic acid.

Angiotensin II Receptor Antagonist/Blocker

As used herein, angiotensin II receptor antagonists or blockers (ARBs)are compounds that modulate the action of angiotensin II by preventingangiotensin II from binding to angiotensin II receptors on the musclessurrounding blood vessels. In some embodiments, the angiotensin IIreceptor blocker is losartan, valsartan, candesartan, eprosartan,irbesartan, telmisartan, or the pharmaceutically acceptable salt orhydrate thereof. In some embodiments, the angiotensin II receptorblocker is losartan. In some embodiments, the angiotensin II receptorblocker is valsartan. In some embodiments, the angiotensin II receptorblocker is candesartan. In some embodiments, the angiotensin II receptorblocker is eprosartan. In some embodiments, the angiotensin II receptorblocker is irbesartan. In some embodiments, the angiotensin II receptorblocker is telmisartan.

Diuretics

As used herein, diuretics refer to compounds that increase urinary flowrate. Diuretics are classified by chemical structure (thiazide diureticsand thiazide-like diuretics), site of action (such as loop diuretic), orpharmacologic effect (such as osmotic diuretics, carbonic anhydraseinhibitors, and potassium sparing diuretics).

In some embodiments, the pharmaceutical compositions disclosed hereincomprise a thiazide diuretic. In some embodiments, the pharmaceuticalcompositions disclosed herein comprise a thiazide-like diuretic. In someembodiments, the pharmaceutical compositions disclosed herein comprise aloop diuretic. In some embodiments, the pharmaceutical compositionsdisclosed herein comprise an osmotic diuretic. In some embodiments, thepharmaceutical compositions disclosed herein comprise a carbonicanhydrase inhibitor. In some embodiments, the pharmaceuticalcompositions disclosed herein comprise a potassium sparing diuretic.

Thiazide Diuretics

As used herein, thiazide diuretics refer to compounds that contain thebenzothiadiazine molecular structure. In some embodiments, thiazidediuretics inhibit sodium and chloride reabsorption in the distal tubuleof the kidney, which results in increased urinary excretion of sodiumand water. Examples of thiazide diuretics include, but are not limitedto, altizide, bendroflumethiazide, chlorothiazide, cyclopenthiazide,cyclothiazide, epitizide, hydrochlorothiazide, hydroflumethiazide,mebutizide, methyclothiazide, polythiazide, and trichlormethiazide.

In some embodiments, the thiazide diuretic is altizide,bendroflumethiazide, chlorothiazide, cyclopenthiazide, cyclothiazide,epitizide, hydrochlorothiazide, hydroflumethiazide, mebutizide,methyclothiazide, polythiazide, trichlormethiazide, or thepharmaceutically acceptable salt or hydrate thereof. In someembodiments, the thiazide diuretic is altizide. In some embodiments, thethiazide diuretic is bendroflumethiazide. In some embodiments, thethiazide diuretic is chlorothiazide. In some embodiments, the thiazidediuretic is cyclopenthiazide. In some embodiments, the thiazide diureticis cyclothiazide. In some embodiments, the thiazide diuretic isepitizide. In some embodiments, the thiazide diuretic ishydrochlorothiazide. In some embodiments, the thiazide diuretic ishydroflumethiazide. In some embodiments, the thiazide diuretic ismebutizide. In some embodiments, the thiazide diuretic ismethyclothiazide. In some embodiments, the thiazide diuretic ispolythiazide. In some embodiments, the thiazide diuretic istrichlormethiazide.

Thiazide-Like Diuretics

As used herein, a thiazide-like diuretic is a sulfonamide diuretic thathas similar physiological properties to a thiazide diuretic, but doesnot have the chemical properties of a thiazide (i.e. does not have thebenzothiadiazine core). Examples of thiazide-like diuretics include, butare not limited to, quinethazone, clopamide, chlorthalidone, mefruside,clofenamide, metolazone, meticrane, xipamide, indapamide, clorexolone,and fenquizone.

In some embodiments, the thiazide-like diuretic is quinethazone,clopamide, chlorthalidone, mefruside, clofenamide, metolazone,meticrane, xipamide, indapamide, clorexolone, fenquizone, or thepharmaceutically acceptable salt or hydrate thereof. In someembodiments, the thiazide-like diuretic is quinethazone. In someembodiments, the thiazide-like diuretic is clopamide. In someembodiments, the thiazide-like diuretic is chlorthalidone. In someembodiments, the thiazide-like diuretic is mefruside. In someembodiments, the thiazide-like diuretic is clofenamide. In someembodiments, the thiazide-like diuretic is metolazone. In someembodiments, the thiazide-like diuretic is meticrane. In someembodiments, the thiazide-like diuretic is xipamide. In someembodiments, the thiazide-like diuretic is indapamide or the hydratethereof. In some embodiments, the thiazide-like diuretic is indapamide.In some embodiments, the thiazide-like diuretic is clorexolone. In someembodiments, the thiazide-like diuretic is fenquizone.

Loop Diuretics

As used herein, loop diuretics are compounds that act on the Na+/K+/2Cl−cotransporter in the thick ascending loop of Henle to inhibit sodium,chloride, and potassium reabsorption.

Examples of loop diuretics include, but are not limited to, furosemide,bumetanide, etacrynic acid, etozolin, muzolimine, ozolinone, piretanide,tienilic acid, and torasemide. In some embodiments, the loop diuretic isfurosemide, bumetanide, etacrynic acid, etozolin, muzolimine, ozolinone,piretanide, tienilic acid, torasemide, or a pharmaceutically acceptablesalt or hydrate thereof.

Other Diuretics

Osmotic diuretics are compounds that cause water to be retained withinthe proximal tubule and descending limb of loop of Henle. In someembodiments, the osmotic diuretic expands fluid and plasma volume andincreases blood flow to the kidney. Examples include, but are notlimited to, mannitol and glycerol.

Carbonic Anhydrase Inhibitors

Carbonic anhydrase inhibitors as used herein are compounds that areinhibitors of carbonic anhydrase. In some embodiments, the carbonicanhydrase inhibitor increases the excretion of bicarbonate withaccompanying sodium, potassium, and water, which results in an increasedflow of alkaline urine. In some embodiments, the carbonic anhydraseinhibitor inhibits the transport of bicarbonate into the interstitiumfrom the proximal convoluted tubule, which leads to less sodium beingreabsorbed and provides greater sodium, bicarbonate and water loss inthe urine. Examples of such compounds include, but are not limited to,acetazolamide, dichlorphenamide, and methazolamide.

Potassium-Sparing Diuretics

Potassium-sparing diuretics are compounds that either compete withaldosterone for intracellular cytoplasmic receptor sites, or directlyblock sodium channels, specifically epithelial sodium channels (ENaC).Examples of potassium-sparing diuretics include, but are not limited to,amiloride, spironolactone, eplerenone, triamterene, potassiumcanrenoate.

Other diuretics contemplated for use also include, but are not limitedto, caffeine, theophylline, theobromine, tolvaptan, conivaptan,dopamine, and pamabrom.

In some embodiments, the diuretic is dichlorphenamide, amiloride,pamabrom, mannitol, acetazolamide, methazolamide, spironolactone,triamterene, or the pharmaceutically acceptable salt or hydrate thereof.In some embodiments, the diuretic is dichlorphenamide. In someembodiments, the diuretic is amiloride. In some embodiments, thediuretic is pamabrom. In some embodiments, the diuretic is mannitol. Insome embodiments, the diuretic is acetazolamide. In some embodiments,the diuretic is methazolamide. In some embodiments, the diuretic isspironolactone. In some embodiments, the diuretic is triamterene.

Calcium Channel Blockers

As used herein, calcium channel blockers are compounds that promotevasodilator activity by reducing calcium influx into vascular smoothmuscle cells. In some embodiments, the calcium channel blocker isamlodipine, nifedipine, diltiazem, nimodipine, verapamil, isradipine,felodipine, nicardipine, nisoldipine, clevidipine, dihydropyridine,lercanidipine, nitrendipine, cilnidipine, manidipine, mibefradil,bepridil, barnidipine, nilvadipine, gallopamil, lidoflazine,aranidipine, dotarizine, diproteverine, or the pharmaceuticallyacceptable salt or hydrate thereof. In some embodiments, the calciumchannel blocker is amlodipine, nifedipine, diltiazem, nimodipine,verapamil, isradipine, felodipine, nicardipine, nisoldipine, clevidipineor the pharmaceutically acceptable salt or hydrate thereof. In someembodiments, the calcium channel blocker is amlodipine or thepharmaceutically acceptable salt thereof. In some embodiments, thecalcium channel blocker is amolodipine besylate. In some embodiments,the calcium channel blocker is nifedipine. In some embodiments, thecalcium channel blocker is diltiazem. In some embodiments, the calciumchannel blocker is nimodipine. In some embodiments, the calcium channelblocker is verapamil. In some embodiments, the calcium channel blockeris isradipine. In some embodiments, the calcium channel blocker isfelodipine. In some embodiments, the calcium channel blocker isnicardipine. In some embodiments, the calcium channel blocker isnisoldipine. In some embodiments, the calcium channel blocker isclevidipine.

Lowest Hyertension Therapeutic Dose

As used herein, the lowest hypertension therapeutic dose (LHTD) refersto the lowest strength dose for the single agent for hypertensionapproved by the US Food and Drug Administration and is not marked as“discontinued” by the Orange Book database(http://www.accessdata.fda.gov/scripts/cder/ob/) as of the filing dateof this application. The lowest hypertension therapeutic dose does notinclude the lowest manufactured dose for cases wherein the lowesthypertension therapeutic dose is not the same as the lowest manufactureddose. Furthermore, the lowest hypertension therapeutic dose does notinclude the dose as recommended by a physician for cases wherein thelowest hypertension therapeutic dose is not the same dose as recommendedby a physician. Further, the lowest hypertension dose of the angiotensinII receptor blocker, diuretic, or calcium channel blocker describedherein refers to the dose of the form of angiotensin II receptorblocker, diuretic, or calcium channel blocker approved for use by the USFood and Drug Administration, which includes the free base,pharmaceutically acceptable salt, or hydrate thereof.

In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 40% to about 80% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 40% to about 70% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 40% to about 60% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 40% to about 50% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 45% to about 55% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 50% to about 80% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 50% to about 70% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 50% to about 60% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 60% to about 80% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 60% to about 70% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isfrom about 70% to about 80% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the angiotensin II receptor blocker isabout 40%, about 41%, about 42%, about 43%, about 44%, about 45%, about46%, about 47%, about 48%, about 49%, about 50%, about 51%, about 52%,about 53%, about 54%, about 55%, about 56%, about 57%, about 58%, about59%, about 60%, about 61%, about 62%, about 63%, about 64%, about 65%,about 66%, about 67%, about 68%, about 69%, about 70%, about 71%, about72%, about 73%, about 74%, about 75%, about 76%, about 77%, about 78%,about 79%, or about 80% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the angiotensin II receptor blocker isabout 40%, about 41%, about 42%, about 43%, about 44%, about 45%, about46%, about 47%, about 48%, about 49%, about 50%, about 51%, about 52%,about 53%, about 54%, about 55%, about 56%, about 57%, about 58%, about59%, or about 60% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the angiotensin II receptor blocker is about45%, about 46%, about 47%, about 48%, about 49%, about 50%, about 51%,about 52%, about 53%, about 54%, or about 55% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the angiotensin IIreceptor blocker is about 50% of the lowest hypertension therapeuticdose. In some embodiments, the dose of the angiotensin II receptorblocker is about 60%, about 61%, about 62%, about 63%, about 64%, about65%, about 66%, about 67%, about 68%, about 69%, about 70%, about 71%,about 72%, about 73%, about 74%, about 75%, about 76%, about 77%, about78%, about 79%, or about 80% of the lowest hypertension therapeuticdose. In some embodiments, the dose of the angiotensin II receptorblocker is about 61%, about 62%, about 63%, about 64%, about 65%, about66%, about 67%, about 68%, about 69%, about 70%, or about 71% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin II receptor blocker is about 66% of the lowesthypertension therapeutic dose.

In some embodiments, the dose of the diuretic is from about 40% to about80% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the diuretic is from about 40% to about 70% of the lowesthypertension therapeutic dose. In some embodiments, the dose of thediuretic is from about 40% to about 60% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the diuretic is fromabout 40% to about 50% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the diuretic is from about 45% to about55% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the diuretic is from about 50% to about 80% of the lowesthypertension therapeutic dose. In some embodiments, the dose of thediuretic is from about 50% to about 70% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the diuretic is fromabout 50% to about 60% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the diuretic is from about 60% to about80% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the diuretic is from about 60% to about 70% of the lowesthypertension therapeutic dose. In some embodiments, the dose of thediuretic is from about 70% to about 80% of the lowest hypertensiontherapeutic dose.

In some embodiments, the dose of the diuretic is about 40%, about 41%,about 42%, about 43%, about 44%, about 45%, about 46%, about 47%, about48%, about 49%, about 50%, about 51%, about 52%, about 53%, about 54%,about 55%, about 56%, about 57%, about 58%, about 59%, about 60%, about61%, about 62%, about 63%, about 64%, about 65%, about 66%0, about 67%,about 68%, about 69%, about 70%, about 71%, about 72%, about 73%, about74%, about 75%, about 76%, about 77%, about 78%, about 79%, or about 80%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the diuretic is about 40%, about 41%, about 42%, about 43%,about 44%, about 45%, about 46%, about 47%, about 48%, about 49%, about50%, about 51%, about 52%, about 53%, about 54%, about 55%, about 56%,about 57%, about 58%, about 59%, or about 60% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the diuretic is about45%, about 46%, about 47%, about 48%, about 49%, about 50%, about 51%,about 52%, about 53%, about 54%, or about 55% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the diuretic is about50% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the diuretic is about 60%, about 61%, about 62%, about 63%,about 64%, about 65%, about 66%, about 67%, about 68%, about 69%, about70%, about 71%, about 72%, about 73%, about 74%, about 75%, about 76%,about 77%, about 78%, about 79%, or about 80% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the diuretic is about61%, about 62%, about 63%, about 64%, about 65%, about 66%, about 67%,about 68%, about 69%, about 70%, or about 71% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the diuretic is about66% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide diuretic is from about 40%to about 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 40% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 40% toabout 60% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 40% toabout 50% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 45% toabout 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 50% toabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 50% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 50% toabout 60% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 60% toabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 60% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is from about 70% toabout 80% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide diuretic is about 40%,about 41%, about 42%, about 43%, about 44%, about 45%, about 46%, about47%, about 48%, about 49%, about 50%, about 51%, about 52%, about 53%,about 54%, about 55%, about 56%, about 57%, about 58%, about 59%, about60%, about 61%, about 62%, about 63%, about 64%, about 65%, about 66%,about 67%, about 68%, about 69%, about 70%, about 71%, about 72%, about73%, about 74%, about 75%, about 76%, about 77%, about 78%, about 79%,or about 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is about 40%, about 41%,about 42%, about 43%, about 44%, about 45%, about 46%, about 47%, about48%, about 49%, about 50%, about 51%, about 52%, about 53%, about 54%,about 55%, about 56%, about 57%, about 58%, about 59%, or about 60% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the thiazide diuretic is about 45%, about 46%, about 47%, about 48%,about 49%, about 50%, about 51%, about 52%, about 53%, about 54%, orabout 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide diuretic is about 50% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe thiazide diuretic is about 60%, about 61%, about 62%, about 63%,about 64%, about 65%, about 66%, about 67%, about 68%, about 69%, about70%, about 71%, about 72%, about 73%, about 74%, about 75%, about 76%,about 77%, about 78%, about 79%, or about 80% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the thiazide diureticis about 61%, about 62%, about 63%, about 64%, about 65%, about 66%,about 67%, about 68%, about 69%, about 70%, or about 71% of the lowesthypertension therapeutic dose. In some embodiments, the dose of thethiazide diuretic is about 66% of the lowest hypertension therapeuticdose.

In some embodiments, the dose of the thiazide-like diuretic is fromabout 40% to about 80% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the thiazide-like diuretic is from about40% to about 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 40% toabout 60% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 40% toabout 50% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 45% toabout 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 50% toabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 50% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 50% toabout 600 of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 60% toabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 60% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 70% toabout 80% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide-like diuretic is about40%, about 41%, about 42%, about 43%, about 44%, about 45%, about 46%,about 47%, about 48%, about 49%, about 50%, about 51%, about 52%, about53%, about 54%, about 55%, about 56%, about 57%, about 58%, about 59%,about 60%, about 61%, about 62%, about 63%, about 64%, about 65%, about66%, about 67%, about 68%, about 69%, about 70%, about 71%, about 72%,about 73%, about 74%, about 75%, about 76%, about 77%, about 78%, about79%, or about 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is about 40%, about41%, about 42%, about 43%, about 44%, about 45%, about 46%, about 47%,about 48%, about 49%, about 50%, about 51%, about 52%, about 53%, about54%, about 55%, about 56%, about 57%, about 58%, about 59%, or about 60%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the thiazide-like diuretic is about 45%, about 46%, about 47%,about 48%, about 49%, about 50%, about 51%, about 52%, about 53%, about54%, or about 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is about 50% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe thiazide-like diuretic is about 60%, about 61%, about 62%, about63%, about 64%, about 65%, about 66%, about 67%, about 68%, about 69%,about 70%, about 71%, about 72%, about 73%, about 74%, about 75%, about76%, about 77%, about 78%, about 79%, or about 80% of the lowesthypertension therapeutic dose. In some embodiments, the dose of thethiazide-like diuretic is about 61%, about 62%, about 63%, about 64%,about 65%, about 66%, about 67%, about 68%, about 69%, about 70%, orabout 71% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is about 66% of thelowest hypertension therapeutic dose.

In some embodiments, the dose of the loop diuretic is from about 40% toabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the loop diuretic is from about 40% to about70% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the loop diuretic is from about 40% to about 60% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe loop diuretic is from about 40% to about 50% of the lowesthypertension therapeutic dose. In some embodiments, the dose of the loopdiuretic is from about 45% to about 55% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the loop diuretic isfrom about 50% to about 80% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the loop diuretic is from about 50% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the loop diuretic is from about 50% to about60% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the loop diuretic is from about 60% to about 80% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe loop diuretic is from about 60% to about 70% of the lowesthypertension therapeutic dose. In some embodiments, the dose of the loopdiuretic is from about 70% to about 80% of the lowest hypertensiontherapeutic dose.

In some embodiments, the dose of the loop diuretic is about 40%, about41%, about 42%, about 43%, about 44%, about 45%, about 46%, about 47%,about 48%, about 49%, about 50%, about 51%, about 52%, about 53%, about54%, about 55%, about 56%, about 57%, about 58%, about 59%, about 60%,about 61%, about 62%, about 63%, about 64%, about 65%, about 66%, about67%, about 68%, about 69%, about 70%, about 71%, about 72%, about 73%,about 74%, about 75%, about 76%, about 77%, about 78%, about 79%, orabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the loop diuretic is about 40%, about 41%,about 42%, about 43%, about 44%, about 45%, about 46%, about 47%, about48%, about 49%, about 50%, about 51%, about 52%, about 53%, about 54%,about 55%, about 56%, about 57%, about 58%, about 59%, or about 60% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the loop diuretic is about 45%, about 46%, about 47%, about 48%,about 49%, about 50%, about 51%, about 52%, about 53%, about 54%, orabout 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the loop diuretic is about 50% of the lowesthypertension therapeutic dose. In some embodiments, the dose of the loopdiuretic is about 60%, about 61%, about 62%, about 63%, about 64%, about65%, about 66%, about 67%, about 68%, about 69%, about 70%, about 71%,about 72%, about 73%, about 74%, about 75%, about 76%, about 77%, about78%, about 79%, or about 80% of the lowest hypertension therapeuticdose. In some embodiments, the dose of the loop diuretic is about 61%,about 62%, about 63%, about 64%, about 65%, about 66%, about 67%, about68%, about 69%, about 70%, or about 71% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the loop diuretic isabout 66% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is fromabout 40% to about 80% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the calcium channel blocker is from about40% to about 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 40%to about 60% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 40%to about 50% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 45%to about 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 50%to about 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 50%to about 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 50%to about 60% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 60%to about 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 60%to about 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 70%to about 80% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is about40%, about 41%, about 42%, about 43%, about 44%, about 45%, about 46%,about 47%, about 48%, about 49%, about 50%, about 51%, about 52%, about53%, about 54%, about 55%, about 56%, about 57%, about 58%, about 59%,about 60%, about 61%, about 62%, about 63%, about 64%, about 65%, about66%, about 67%, about 68%, about 69%, about 70%, about 71%, about 72%,about 73%, about 74%, about 75%, about 76%, about 77%, about 78%, about79%, or about 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is about 40%, about41%, about 42%, about 43%, about 44%, about 45%, about 46%, about 47%,about 48%, about 49%, about 50%, about 51%, about 52%, about 53%, about54%, about 55%, about 56%, about 57%, about 58%, about 59%, or about 60%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the calcium channel blocker is about 45%, about 46%, about 47%,about 48%, about 49%, about 50%, about 51%, about 52%, about 53%, about54%, or about 55% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is about 50% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe calcium channel blocker is about 60%, about 61%, about 62%, about63%, about 64%, about 65%, about 66%, about 67%, about 68%, about 69%,about 70%, about 71%, about 72%, about 73%, about 74%, about 75%, about76%, about 77%, about 78%, about 79%, or about 80% of the lowesthypertension therapeutic dose. In some embodiments, the dose of thecalcium channel blocker is about 61%, about 62%, about 63%, about 64%,about 65%, about 66%, about 67%, about 68%, about 69%, about 70%, orabout 71% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is about 66% of thelowest hypertension therapeutic dose.

In some embodiments, the lowest hypertension therapeutic dose (LHTD) andthe corresponding proposed dose and proposed dose range for thefollowing compounds are as described in the following table:

TABLE 1 Lowest Hypertension Proposed Proposed Dose Therapeutic Dose (mg)Range (mg) Agent Dose (mg) (% LHTD) (% LHTD) Amlodipine besylate 2.51.25 (50% of 1-1.5 (40%-60% of LHTD) or LHTD) or 1.65 (66% of 1.5-2(60%-80% of LHTD) LHTD) Chlorthalidone 25 12.5 (50% of 10-15 (40%-60% ofLHTD) or LHTD) or 16.5 (66% of 15-20 (60%-80% of LHTD) LHTD)Hydrochlorothiazide 12.5 6.25 (50% of 5-7.5 (40%-60% of LHTD) or LHTD)or 8.25 (66% of 7.5-10 (60%-80% LHTD) of LHTD) Indapamide 1.25 0.625(50% 0.5-0.75 (40%-60% of LHTD) or of LHTD) or 0.825 (66% 0.75-1.0(60%-80% of LHTD) of LHTD) Irbesartan 75 37.5 (50% of 30-45 (40%-60% ofLHTD) or LHTD) or 49.5 (66% of 45-60 (60%-80% of LHTD) LHTD) Telmisartan20 10 (50% of 8-12 (40%-60% of LHTD) or LHTD) or 13.2 (66% of 12-16(60%-80% of LHTD) LHTD)

In some embodiments, the pharmaceutical composition comprises: (a)irbesartan as an angiotensin II receptor blocker; (b)hydrochlorothiazide as a thiazide diuretic; and (c) amlodipine besylateas a calcium channel blocker. In some embodiments, the dose ofirbesartan is from about 30 mg to about 45 mg, the dose ofhydrochlorothiazide is from about 5 mg to about 7.5 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg. In someembodiments, the dose of irbesartan is about 37.5 mg, the dose ofhydrochlorothiazide is about 6.25 mg, and the dose of amlodipinebesylate is about 1.25 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b)hydrochlorothiazide as a thiazide diuretic; and (c) amlodipine besylateas a calcium channel blocker. In some embodiments, the dose oftelmisartan is from about 8 mg to about 12 mg, the dose ofhydrochlorothiazide is from about 5 mg to about 7.5 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg. In someembodiments, the dose of telmisartan is about 10 mg, the dose ofhydrochlorothiazide is about 6.25 mg, and the dose of amlodipinebesylate is about 1.25 mg.

In some embodiments, the pharmaceutical composition comprises: (a)irbesartan as an angiotensin II receptor blocker; (b) indapamide as athiazide-like diuretic; and (c) amlodipine besylate as a calcium channelblocker. In some embodiments, the dose of irbesartan is from about 30 mgto about 45 mg, the dose of indapamide is from about 0.5 mg to about0.75 mg, and the dose of amlodipine besylate is from about 1 mg to about1.5 mg. In some embodiments, the dose of irbesartan is about 37.5 mg,the dose of indapamide is about 0.625 mg, and the dose of amlodipinebesylate is about 1.25 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b) indapamide as athiazide-like diuretic; (c) amlodipine besylate as a calcium channelblocker. In some embodiments, the dose of telmisartan is from about 8 mgto about 12 mg, the dose of indapamide is from about 0.5 mg to about0.75 mg, and the dose of amlodipine besylate is from about 1 mg to about1.5 mg. In some embodiments, dose of telmisartan is about 10 mg, thedose of indapamide is about 0.625 mg, and the dose of amlodipinebesylate is about 1.25 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b) chlorthalidone asa thiazide-like diuretic; and (c) amlodipine besylate as a calciumchannel blocker. In some embodiments, the dose of telmisartan is fromabout 8 mg to about 12 mg, the dose of chlorthalidone is from about 10mg to about 15 mg, and the dose of amlodipine besylate is from about 1mg to about 1.5 mg. In some embodiments, dose of telmisartan is about 10mg, the dose of chlorthalidone is about 12.5 mg, and the dose ofamlodipine besylate is about 1.25 mg.

In some embodiments, the pharmaceutical composition comprises: (a)irbesartan as an angiotensin II receptor blocker; (b) chlorthalidone asa thiazide-like diuretic; and (c) amlodipine besylate as a calciumchannel blocker. In some embodiments, the dose of irbesartan is fromabout 30 mg to about 45 mg, the dose of chlorthalidone is from about 10mg to about 15 mg, and the dose of amlodipine besylate is from about 1mg to about 1.5 mg. In some embodiments, dose of irbesartan is about37.5 mg, the dose of chlorthalidone is about 12.5 mg, and the dose ofamlodipine besylate is about 1.25 mg.

In some embodiments, the pharmaceutical composition comprises: (a)irbesartan as an angiotensin II receptor blocker; (b)hydrochlorothiazide as a thiazide diuretic; and (c) amlodipine besylateas a calcium channel blocker. In some embodiments, the dose ofirbesartan is from about 45 mg to about 60 mg, the dose ofhydrochlorothiazide is from about 7.5 mg to about 10 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg. In someembodiments, the dose of irbesartan is about 49.5 mg, the dose ofhydrochlorothiazide is about 8.25 mg, and the dose of amlodipinebesylate is about 1.65 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b)hydrochlorothiazide as a thiazide diuretic; and (c) amlodipine besylateas a calcium channel blocker. In some embodiments, the dose oftelmisartan is from about 12 mg to about 16 mg, the dose ofhydrochlorothiazide is from about 7.5 mg to about 10 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg. In someembodiments, the dose of telmisartan is about 13.2 mg, the dose ofhydrochlorothiazide is about 8.25 mg, and the dose of amlodipinebesylate is about 1.65 mg.

In some embodiments, the pharmaceutical composition comprises: (a)irbesartan as an angiotensin II receptor blocker; (b) indapamide as athiazide-like diuretic; and (c) amlodipine besylate as a calcium channelblocker. In some embodiments, the dose of irbesartan is from about 45 mgto about 60 mg, the dose of indapamide is from about 0.75 mg to about1.0 mg, and the dose of amlodipine besylate is from about 1.5 mg toabout 2 mg. In some embodiments, the dose of irbesartan is about 49.5mg, the dose of indapamide is about 0.825 mg, and the dose of amlodipinebesylate is about 1.65 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b) indapamide as athiazide-like diuretic; (c) amlodipine besylate as a calcium channelblocker. In some embodiments, the dose of telmisartan is from about 12mg to about 16 mg, the dose of indapamide is from about 0.75 mg to about1.0 mg, and the dose of amlodipine besylate is from about 1.5 mg toabout 2 mg. In some embodiments, dose of telmisartan is about 13.2 mg,the dose of indapamide is about 0.825 mg, and the dose of amlodipinebesylate is about 1.65 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b) chlorthalidone asa thiazide-like diuretic; and (c) amlodipine besylate as a calciumchannel blocker. In some embodiments, the dose of telmisartan is fromabout 12 mg to about 16 mg, the dose of chlorthalidone is from about 15mg to about 20 mg, and the dose of amlodipine besylate is from about 1.5mg to about 2 mg. In some embodiments, dose of telmisartan is about 13.2mg, the dose of chlorthalidone is about 16.5 mg, and the dose ofamlodipine besylate is about 1.65 mg.

In some embodiments, the pharmaceutical composition comprises: (a)irbesartan as an angiotensin II receptor blocker; (b) chlorthalidone asa thiazide-like diuretic; and (c) amlodipine besylate as a calciumchannel blocker. In some embodiments, the dose of irbesartan is fromabout 45 mg to about 60 mg, the dose of chlorthalidone is from about 15mg to about 20 mg, and the dose of amlodipine besylate is from about 1.5mg to about 2 mg. In some embodiments, dose of irbesartan is about 49.5mg, the dose of chlorthalidone is about 16.5 mg, and the dose ofamlodipine besylate is about 1.65 mg.

In some embodiments, the dose of the angiotensin II receptor blocker,such as telmisartan, is from about 80% to about 150% of the lowesthypertension therapeutic dose. In some embodiments, the dose of theangiotensin II receptor blocker is from about 80% to about 140% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin II receptor blocker is from about 80% to about 130% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the angiotensin II receptor blocker is from about 80% to about 120%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the angiotensin II receptor blocker is from about 80% to about110% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the angiotensin II receptor blocker,such as telmisartan, is from about 85% to about 145% of the lowesthypertension therapeutic dose. In some embodiments, the dose of theangiotensin II receptor blocker is from about 85% to about 135% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin II receptor blocker is from about 85% to about 125% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the angiotensin II receptor blocker is from about 85% to about 115%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the angiotensin II receptor blocker is from about 85% to about105% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the angiotensin II receptor blocker,such as telmisartan, is from about 90% to about 140% of the lowesthypertension therapeutic dose. In some embodiments, the dose of theangiotensin II receptor blocker is from about 90% to about 130% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin II receptor blocker is from about 90% to about 120% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the angiotensin II receptor blocker is from about 90% to about 110%of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the angiotensin II receptor blocker,such as telmisartan, is from about 95% to about 135% of the lowesthypertension therapeutic dose. In some embodiments, the dose of theangiotensin II receptor blocker is from about 95% to about 125% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin II receptor blocker is from about 95% to about 115% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the angiotensin II receptor blocker is from about 95% to about 105%of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the angiotensin II receptor blocker isabout 80%, about 81%, about 82%, about 83%, about 84%, about 85%, about86%, about 87%, about 88%, about 89%, about 90%, about 91%, about 92%,about 93%, about 94%, about 95%, about 96%, about 97%, about 98%, about99%, about 100%, about 101%, about 102%, about 103%, about 104%, about105%, about 106%, about 107%, about 108%, about 109%, about 110%, about111%, about 112%, about 113%, about 114%, about 115%, about 116%, about117%, about 118%, about 119%, or about 120% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the angiotensin IIreceptor blocker is about 90%, about 91%, about 92%, about 93%, about94%, about 95%, about 96%, about 97%, about 98%, about 99%, about 100%,about 101%, about 102%, about 103%, about 104%, about 105%, about 106%,about 107%, about 108%, about 109%, or about 110% of the lowesthypertension therapeutic dose. In some embodiments, the dose of theangiotensin II receptor blocker is about 95%, about 96%, about 97%,about 98%, about 99%, about 100%, about 101%, about 102%, about 103%,about 104%, or about 105% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin II receptor blocker isabout 100% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide-like diuretic is fromabout 80% to about 150% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the thiazide-like diuretic is from about80% to about 140% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 80% toabout 130% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 80% toabout 120% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 80% toabout 110% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide-like diuretic is fromabout 85% to about 145% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the thiazide-like diuretic is from about85% to about 135% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 85% toabout 125% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 85% toabout 115% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 85% toabout 105% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide-like diuretic is fromabout 90% to about 140% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the thiazide-like diuretic is from about90% to about 130% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 90% toabout 120% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 90% toabout 110% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide-like diuretic is fromabout 95% to about 135% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the thiazide-like diuretic is from about95% to about 125% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 95% toabout 115% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the thiazide-like diuretic is from about 95% toabout 105% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the thiazide-like diuretic is about80%, about 81%, about 82%, about 83%, about 84%, about 85%, about 86%,about 87%, about 88%, about 89%, about 90%, about 91%, about 92%, about93%, about 94%, about 95%, about 96%, about 97%, about 98%, about 99%,about 100%, about 101%, about 102%, about 103%, about 104%, about 105%,about 106%, about 107%, about 108%, about 109%, about 110%, about 111%,about 112%, about 113%, about 114%, about 115%, about 116%, about 117%,about 118%, about 119%, or about 120% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the thiazide-likediuretic is about 90%, about 91%, about 92%, about 93%, about 94%, about95%, about 96%, about 97%, about 98%, about 99%, about 100%, about 101%,about 102%, about 103%, about 104%, about 105%, about 106%, about 107%,about 108%, about 109%, or about 110% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the thiazide-likediuretic is about 95%, about 96%, about 97%, about 98%, about 99%, about100%, about 101%, about 102%, about 103%, about 104%, or about 105% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the thiazide-like diuretic blocker is about 100% of the lowesthypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is fromabout 80% to about 150% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the calcium channel blocker is from about80% to about 140% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 80%to about 130% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 80%to about 120% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 80%to about 110% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is fromabout 85% to about 145% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the calcium channel blocker is from about85% to about 135% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 85%to about 125% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 85%to about 115% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 85%to about 105% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is fromabout 90% to about 140% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the calcium channel blocker is from about90% to about 130% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 90%to about 120% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 90%to about 110% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is fromabout 95% to about 135% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the calcium channel blocker is from about95% to about 125% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 95%to about 115% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the calcium channel blocker is from about 95%to about 105% of the lowest hypertension therapeutic dose.

In some embodiments, the dose of the calcium channel blocker is about80%, about 81%, about 82%, about 83%, about 84%, about 85%, about 86%,about 87%, about 88%, about 89%, about 90%, about 91%, about 92%, about93%, about 94%, about 95%, about 96%, about 97%, about 98%, about 99%,about 100%, about 101%, about 102%, about 103%, about 104%, about 105%,about 106%, about 107%, about 108%, about 109%, about 110%, about 111%,about 112%, about 113%, about 114%, about 115%, about 116%, about 117%,about 118%, about 119%, or about 120% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the calcium channelblocker is about 90%, about 91%, about 92%, about 93%, about 94%, about95%, about 96%, about 97%, about 98%, about 99%, about 100%, about 101%,about 102%, about 103%, about 104%, about 105%, about 106%, about 107%,about 108%, about 109%, or about 110% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of the calcium channelblocker is about 95%, about 96%, about 97%, about 98%, about 99%, about100%, about 101%, about 102%, about 103%, about 104%, or about 105% ofthe lowest hypertension therapeutic dose. In some embodiments, the doseof the calcium channel blocker is about 100% of the lowest hypertensiontherapeutic dose.

In some embodiments, the lowest hypertension therapeutic dose (LHTD) andthe corresponding proposed dose and proposed dose range for thefollowing compounds are as described in the following table:

TABLE 2 Lowest Hypertension Proposed Proposed Dose Therapeutic Dose (mg)Range (mg) Agent Dose (mg) (% LHTD) (% LHTD) Amlodipine besylate 2.5 2.5(100% of 2-3.75 (80%-150% LHTD) or of LHTD); 5 (200% of 2-3 (80%-120% ofLHTD) LHTD); 2.25-2.75 (90%- 110% of LHTD); or 3.75-6.25 (150%- 250% ofLHTD) Chlorthalidone 25 25 (100% of 20-37.5 (80%- LHTD) or 150% ofLHTD); 50 (200% of 20-30 (80%-120% LHTD) of LHTD); 22.5-27.5 (90%- 110%of LHTD); or 37.5-62.5 (150%- 250% of LHTD) Hydrochlorothiazide 12.512.5 (100% 10-18.75 (80%- of LHTD) or 150% of LHTD); 25 (200% of 10-15(80%-120%) LHTD) of LHTD); 11.25-13.75 (90%- 110% of LHTD); or18.75-31.25 (150%- 250% of LHTD) Indapamide 1.25 1.25 (100% 1-1.875(80%-150% of LHTD) or of LHTD); 2.5 (200% of 1-1.5 (80%-120% LHTD) ofLHTD); 1.125-1.375 (90%- 110% of LHTD); or 1.875-3.125 (150%- 250% ofLHTD) Irbesartan 75 75 (100% of 60-112.5 (80%- LHTD) or 150% of LHTD);150 (200% of 60-90 (80%-120% LHTD) of LHTD); 67.5-82.5 (90%- 110% ofLHTD); or 112.5-187.5 (150%- 250% of LHTD) Telmisartan 20 20 (100% of16-30 (80%-150% LHTD) or of LHTD); 40 (200% of 16-24 (80%-120% LHTD) ofLHTD); 18-22 (90%-110% of LHTD); or 30-50 (150%-250% of LHTD)

In some embodiments, the dose of any one of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 80% to about 250% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker, the diuretic, orthe calcium channel blocker. In some embodiments, the dose of theangiotensin II receptor blocker is substituted with from about 80% toabout 250% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker. In some embodiments, the dose of thediuretic is substituted with from about 80% to about 250% of the lowesthypertension therapeutic dose (LHTD) for the diuretic. In someembodiments, the dose of the calcium channel blocker is substituted withfrom about 80% to about 250% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker. In some embodiments, the dose ofany one of the angiotensin II receptor blocker, the diuretic, and thecalcium channel blocker is substituted with from about 80% to about 150%of the lowest hypertension therapeutic dose (LHTD) for the angiotensinII receptor blocker, the diuretic, or the calcium channel blocker. Insome embodiments, the dose of the angiotensin II receptor blocker issubstituted with from about 80% to about 150% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker. In someembodiments, the dose of the angiotensin II receptor blocker issubstituted with about 100% of the lowest hypertension therapeutic dose(LHTD) for the angiotensin II receptor blocker. In some embodiments, thedose of the diuretic is substituted with from about 80% to about 150% ofthe lowest hypertension therapeutic dose (LHTD) for the diuretic. Insome embodiments, the dose of the diuretic is substituted with about100% of the lowest hypertension therapeutic dose (LHTD) for thediuretic. In some embodiments, the dose of the calcium channel blockeris substituted with from about 80% to about 150% of the lowesthypertension therapeutic dose (LHTD) for the calcium channel blocker. Insome embodiments, the dose of the calcium channel blocker is substitutedwith about 100% of the lowest hypertension therapeutic dose (LHTD) forthe calcium channel blocker. In some embodiments, the dose of any one ofthe angiotensin II receptor blocker, the diuretic, and the calciumchannel blocker is substituted with from about 150% to about 250% of thelowest hypertension therapeutic dose (LHTD) for the angiotensin IIreceptor blocker, the diuretic, or the calcium channel blocker. In someembodiments, the dose of the angiotensin II receptor blocker issubstituted with from about 150% to about 250% of the lowesthypertension therapeutic dose (LHTD) for the angiotensin II receptorblocker. In some embodiments, the dose of the angiotensin II receptorblocker is substituted with about 200% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker. In someembodiments, the dose of the diuretic is substituted with from about150% to about 250% of the lowest hypertension therapeutic dose (LHTD)for the diuretic. In some embodiments, the dose of the diuretic issubstituted with about 200% of the lowest hypertension therapeutic dose(LHTD) for the diuretic. In some embodiments, the dose of the calciumchannel blocker is substituted with from about 150% to about 250% of thelowest hypertension therapeutic dose (LHTD) for the calcium channelblocker. In some embodiments, the dose of the calcium channel blocker issubstituted with about 200% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker.

In some embodiments, the dose of any two of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 80% to about 250% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker, the diuretic, orthe calcium channel blocker. In some embodiments, the dose of theangiotensin II receptor blocker is substituted with from about 80% toabout 250% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker. In some embodiments, the dose of thediuretic is substituted with from about 80% to about 250% of the lowesthypertension therapeutic dose (LHTD) for the diuretic. In someembodiments, the dose of the calcium channel blocker is substituted withfrom about 80% to about 250% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker. In some embodiments, the dose ofany two of the angiotensin II receptor blocker, the diuretic, and thecalcium channel blocker is substituted with from about 80% to about 150%of the lowest hypertension therapeutic dose (LHTD) for the angiotensinII receptor blocker, the diuretic, or the calcium channel blocker. Insome embodiments, the dose of the angiotensin II receptor blocker issubstituted with from about 80% to about 150% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker. In someembodiments, the dose of the angiotensin 1 receptor blocker issubstituted with about 100% of the lowest hypertension therapeutic dose(LHTD) for the angiotensin II receptor blocker. In some embodiments, thedose of the diuretic is substituted with from about 80% to about 150% ofthe lowest hypertension therapeutic dose (LHTD) for the diuretic. Insome embodiments, the dose of the diuretic is substituted with about100% of the lowest hypertension therapeutic dose (LHTD) for thediuretic. In some embodiments, the dose of the calcium channel blockeris substituted with from about 80% to about 150% of the lowesthypertension therapeutic dose (LHTD) for the calcium channel blocker. Insome embodiments, the dose of the calcium channel blocker is substitutedwith about 100% of the lowest hypertension therapeutic dose (LHTD) forthe calcium channel blocker. In some embodiments, the dose of any two ofthe angiotensin 1 receptor blocker, the diuretic, and the calciumchannel blocker is substituted with from about 150% to about 250% of thelowest hypertension therapeutic dose (LHTD) for the angiotensin IIreceptor blocker, the diuretic, or the calcium channel blocker. In someembodiments, the dose of the angiotensin II receptor blocker issubstituted with from about 150% to about 250% of the lowesthypertension therapeutic dose (LHTD) for the angiotensin II receptorblocker. In some embodiments, the dose of the angiotensin II receptorblocker is substituted with about 200% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker. In someembodiments, the dose of the diuretic is substituted with from about150% to about 250% of the lowest hypertension therapeutic dose (LHTD)for the diuretic. In some embodiments, the dose of the diuretic issubstituted with about 200% of the lowest hypertension therapeutic dose(LHTD) for the diuretic. In some embodiments, the dose of the calciumchannel blocker is substituted with from about 150% to about 250% of thelowest hypertension therapeutic dose (LHTD) for the calcium channelblocker. In some embodiments, the dose of the calcium channel blocker issubstituted with about 200% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker.

In some embodiments, the dose of the angiotensin II receptor blocker,the diuretic (e.g., a thiazide diuretic or thiazide-like diuretic), andthe calcium channel blocker are each independently from about 80% toabout 150% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker, the diuretic, or the calcium channelblocker. In some embodiments, the dose of the angiotensin II receptorblocker is from about 80% to about 150% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker. In someembodiments, the dose of the diuretic is from about 80% to about 150% ofthe lowest hypertension therapeutic dose (LHTD) for the diuretic. Insome embodiments, the dose of the calcium channel blocker is from about80% to about 150% of the lowest hypertension therapeutic dose (LHTD) forthe calcium channel blocker. In some embodiments, the dose of theangiotensin II receptor blocker, the diuretic, and the calcium channelblocker are each independently from about 80% to about 120% of thelowest hypertension therapeutic dose (LHTD) for the angiotensin IIreceptor blocker, the diuretic, or the calcium channel blocker. In someembodiments, the dose of the angiotensin II receptor blocker is fromabout 80% to about 120% of the lowest hypertension therapeutic dose(LHTD) for the angiotensin II receptor blocker. In some embodiments, thedose of the angiotensin II receptor blocker is about 100% of the lowesthypertension therapeutic dose (LHTD) for the angiotensin II receptorblocker. In some embodiments, the dose of the diuretic is from about 80%to about 120% of the lowest hypertension therapeutic dose (LHTD) for thediuretic. In some embodiments, the dose of the diuretic is about 100% ofthe lowest hypertension therapeutic dose (LHTD) for the diuretic. Insome embodiments, the dose of the calcium channel blocker is from about80% to about 120% of the lowest hypertension therapeutic dose (LHTD) forthe calcium channel blocker. In some embodiments, the dose of thecalcium channel blocker is about 100% of the lowest hypertensiontherapeutic dose (LHTD) for the calcium channel blocker. In someembodiments, the dose of the angiotensin II receptor blocker, thediuretic, and the calcium channel blocker are each independently fromabout 90% to about 110% of the lowest hypertension therapeutic dose(LHTD) for the angiotensin II receptor blocker, the diuretic, or thecalcium channel blocker. In some embodiments, the dose of theangiotensin II receptor blocker is from about 90% to about 110% of thelowest hypertension therapeutic dose (LHTD) for the angiotensin IIreceptor blocker. In some embodiments, the dose of the angiotensin IIreceptor blocker is about 100% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker. In someembodiments, the dose of the diuretic is about 90% to about 110% of thelowest hypertension therapeutic dose (LHTD) for the diuretic. In someembodiments, the dose of the diuretic is about 100% of the lowesthypertension therapeutic dose (LHTD) for the diuretic. In someembodiments, the dose of the calcium channel blocker is from about 90%to about 110% of the lowest hypertension therapeutic dose (LHTD) for thecalcium channel blocker. In some embodiments, the dose of the calciumchannel blocker is about 100% of the lowest hypertension therapeuticdose (LHTD) for the calcium channel blocker.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b) indapamide as athiazide-like diuretic; (c) amlodipine besylate as a calcium channelblocker. In some embodiments, the dose of telmisartan is from about 16mg to about 30 mg, the dose of indapamide is from about 1 mg to about1.875 mg, and the dose of amlodipine besylate is from about 2 mg toabout 3.75 mg.

In some embodiments, the dose of telmisartan is from about 16 mg toabout 24 mg, the dose of indapamide is from about 1 mg to about 1.5 mg,and the dose of amlodipine besylate is from about 2 mg to about 3 mg.

In some embodiments, the dose of telmisartan is from about 18 mg toabout 22 mg, the dose of indapamide is from about 1.125 mg to about1.375 mg, and the dose of amlodipine besylate is from about 2.25 mg toabout 2.75 mg.

In some embodiments, dose of telmisartan is about 20 mg, the dose ofindapamide is about 1.25 mg, and the dose of amlodipine besylate isabout 2.5 mg.

In some embodiments, the pharmaceutical composition comprises: (a)telmisartan as an angiotensin II receptor blocker; (b) chlorthalidone asa thiazide-like diuretic; and (c) amlodipine besylate as a calciumchannel blocker. In some embodiments, the dose of telmisartan is fromabout 16 mg to about 30 mg, the dose of chlorthalidone is from about 20mg to about 37.5 mg, and the dose of amlodipine besylate is from about 2mg to about 3.75 mg.

In some embodiments, the dose of telmisartan is from about 16 mg toabout 24 mg, the dose of chlorthalidone is from about 20 mg to about 30mg, and the dose of amlodipine besylate is from about 2 mg to about 3mg.

In some embodiments, the dose of telmisartan is from about 18 mg toabout 22 mg, the dose of chlorthalidone is from about 22.5 mg to about27.5 mg, and the dose of amlodipine besylate is from about 2.25 mg toabout 2.75 mg.

In some embodiments, dose of telmisartan is about 20 mg, the dose ofchlorthalidone is about 25 mg, and the dose of amlodipine besylate isabout 2.5 mg.

Formulations

In some embodiments, the angiotensin II receptor blocker, the diuretic,and the calcium channel blocker are provided in one formulation. In someembodiments, the angiotensin II receptor blocker, the diuretic, and thecalcium channel blocker each provided in a separate formulation. In someembodiments, two of the angiotensin II receptor blocker, the diuretic,and the calcium channel blocker are provided in one formulation. In someembodiments, the angiotensin II receptor and the diuretic are providedin one formulation. In some embodiments, the angiotensin II receptorblocker and the calcium channel blocker are provided in one formulation.In some embodiments, the diuretic and the calcium channel blocker areprovided in one formulation. In some embodiments, the angiotensin IIreceptor blocker, the diuretic, and the calcium channel blocker areprovided in one formulation. In some embodiments, the pharmaceuticalcomposition is in the form of pill, tablet, or capsule. In someembodiments, the pharmaceutical composition is in the form of pill. Insome embodiments, the pharmaceutical composition is in the form oftablet. In some embodiments, the pharmaceutical composition is in theform of capsule. In some embodiments, the pharmaceutical composition issuitable for oral administration.

Other suitable formulations include, but are not limited to, thosesuitable for rectal, topical, buccal, parenteral (e.g., subcutaneous,intramuscular, intradermal, or intravenous) rectal, vaginal, or aerosoladministration, although the most suitable form of administration in anygiven case will depend on the degree and severity of the condition beingtreated and on the nature of the particular compound being used. Forexample, disclosed compositions may be formulated as a unit dose.

Exemplary pharmaceutical compositions may be used in the form of apharmaceutical preparation, for example, in solid, semisolid, or liquidform, which includes one or more of a disclosed compound, as an activeingredient, in admixture with an organic or inorganic carrier orexcipient suitable for external, enteral, or parenteral applications.The active ingredient may be compounded, for example, with the usualnon-toxic, pharmaceutically acceptable carriers for tablets, pellets,capsules, suppositories, solutions, emulsions, suspensions, and anyother form suitable for use. The active object compound is included inthe pharmaceutical composition in an amount sufficient to produce thedesired effect upon the process or condition of the disease.

For preparing solid compositions such as tablets, the principal activeingredient may be mixed with a pharmaceutical carrier, e.g.,conventional tableting ingredients such as corn starch, lactose,sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalciumphosphate or gums, and other pharmaceutical diluents, e.g., water, toform a solid preformulation composition containing a homogeneous mixtureof a disclosed compound or a non-toxic pharmaceutically acceptable saltthereof. When referring to these preformulation compositions ashomogeneous, it is meant that the active ingredient is dispersed evenlythroughout the composition so that the composition may be readilysubdivided into equally effective unit dosage forms such as tablets,pills, and capsules.

In solid dosage forms for oral administration (capsules, tablets, pills,dragees, powders, granules and the like), the subject composition ismixed with one or more pharmaceutically acceptable carriers, such assodium citrate or dicalcium phosphate, and/or any of the following: (1)fillers or extenders, such as starches, lactose, sucrose, glucose,mannitol, and/or silicic acid; (2) binders, such as, for example,carboxymethylcellulose, alginates, gelatin, polyvinyl pyrrolidone,sucrose and/or acacia; (3) humectants, such as glycerol; (4)disintegrating agents, such as agar-agar, calcium carbonate, potato ortapioca starch, alginic acid, certain silicates, and sodium carbonate;(5) solution retarding agents, such as paraffin; (6) absorptionaccelerators, such as quaternary ammonium compounds; (7) wetting agents,such as, for example, acetyl alcohol and glycerol monostearate; (8)absorbents, such as kaolin and bentonite clay; (9) lubricants, such atalc, calcium stearate, magnesium stearate, solid polyethylene glycols,sodium lauryl sulfate, and mixtures thereof; and (10) coloring agents.In the case of capsules, tablets and pills, the compositions may alsocomprise buffering agents. Solid compositions of a similar type may alsobe employed as fillers in soft and hard-filled gelatin capsules usingsuch excipients as lactose or milk sugars, as well as high molecularweight polyethylene glycols and the like.

A tablet may be made by compression or molding, optionally with one ormore accessory ingredients. Compressed tablets may be prepared usingbinder (for example, gelatin or hydroxypropylmethyl cellulose),lubricant, inert diluent, preservative, disintegrant (for example,sodium starch glycolate or cross-linked sodium carboxymethyl cellulose),surface-active or dispersing agent. Molded tablets may be made bymolding in a suitable machine a mixture of the subject compositionmoistened with an inert liquid diluent. In some embodiments, capsulesare prepared by encapsulating tablets in hard-gelatin capsules (e.g.overencapsulation.) Tablets, and other solid dosage forms, such asdragees, capsules, pills and granules, may optionally be scored orprepared with coatings and shells, such as enteric coatings and othercoatings well known in the pharmaceutical-formulating art.

In some embodiments, the angiotensin II receptor blockers of thepharmaceutical compositions described herein can be replaced withangiotensin converting enzyme inhibitors (ACE inhibitors). Examples ofsuitable angiotensin converting enzyme inhibitors include, but are notlimited to, benazepril, captopril, enalapril, fosinopril, lisinopril,moexipril, perindopril, quinapril, ramipril, trandolapril or thepharmaceutically acceptable salt or hydrate thereof. In someembodiments, the dose of the angiotensin-converting enzyme inhibitor isfrom about 80% to about 150% of the lowest hypertension therapeuticdose. In some embodiments, the dose of the angiotensin-converting enzymeinhibitor is from about 80% to about 120% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of theangiotensin-converting enzyme inhibitor is from about 90% to about 110%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the angiotensin-converting enzyme inhibitor is about 100% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin-converting enzyme inhibitor is from about 40% to about80% of the lowest hypertension therapeutic dose. In some embodiments,the dose of the angiotensin-converting enzyme inhibitor is from about40% to about 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the angiotensin-converting enzyme inhibitor isfrom about 40% to about 60% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin-converting enzymeinhibitor is from about 40% to about 50% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of theangiotensin-converting enzyme inhibitor is from about 45% to about 55%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the angiotensin-converting enzyme inhibitor is from about 50% toabout 80% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the angiotensin-converting enzyme inhibitor isfrom about 50% to about 70% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin-converting enzymeinhibitor is from about 50% to about 60% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of theangiotensin-converting enzyme inhibitor is from about 60% to about 80%of the lowest hypertension therapeutic dose. In some embodiments, thedose of the angiotensin-converting enzyme inhibitor is from about 60% toabout 70% of the lowest hypertension therapeutic dose. In someembodiments, the dose of the angiotensin-converting enzyme inhibitor isfrom about 70% to about 80% of the lowest hypertension therapeutic dose.In some embodiments, the dose of the angiotensin-converting enzymeinhibitor is about 40%, about 41%, about 42%, about 43%, about 44%,about 45%, about 46%, about 47%, about 48%, about 49%, about 50%, about51%, about 52%, about 53%, about 54%, about 55%, about 56%, about 57%,about 58%, about 59%, about 60%, about 61%, about 62%, about 63%, about64%, about 65%, about 66%, about 67%, about 68%, about 69%, about 70%,about 71%, about 72%, about 73%, about 74%, about 75%, about 76%, about77%, about 78%, about 79%, or about 80% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of theangiotensin-converting enzyme inhibitor is about 40%, about 41%, about42%, about 43%, about 44%, about 45%, about 46%, about 47%, about 48%,about 49%, about 50%, about 51%, about 52%, about 53%, about 54%, about55%, about 56%, about 57%, about 58%, about 59%, or about 60% of thelowest hypertension therapeutic dose. In some embodiments, the dose ofthe angiotensin-converting enzyme inhibitor is about 45%, about 46%,about 47%, about 48%, about 49%, about 50%, about 51%, about 52%, about53%, about 54%, or about 55% of the lowest hypertension therapeuticdose. In some embodiments, the dose of the angiotensin-converting enzymeinhibitor is about 50% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the angiotensin-converting enzymeinhibitor is about 60%, about 61%, about 62%, about 63%, about 64%,about 65%, about 66%, about 67%, about 68%, about 69%, about 70%, about71%, about 72%, about 73%, about 74%, about 75%, about 76%, about 77%,about 78%, about 79%, or about 80% of the lowest hypertensiontherapeutic dose. In some embodiments, the dose of theangiotensin-converting enzyme inhibitor is about 61%, about 62%, about63%, about 64%, about 65%, about 66%, about 67%, about 68%, about 69%,about 70%, or about 71% of the lowest hypertension therapeutic dose. Insome embodiments, the dose of the angiotensin-converting enzymeinhibitor is about 66% of the lowest hypertension therapeutic dose.

Methods of Treatment

The pharmaceutical compositions described herein are useful for treatinghypertension in a subject in need thereof. In some embodiments, thetreatment results in a systolic blood pressure (SBP) of less than about140 mmHg. In some embodiments, the treatment results in a systolic bloodpressure (SBP) of less than about 135 mmHg. In some embodiments, thetreatment results in a reduction of systolic blood pressure (SBP) ofabout 10 mmHg or greater. In some embodiments, the treatment results ina reduction of systolic blood pressure (SBP) of about 10 mmHg to about20 mmHg. In some embodiments, the treatment results in a reduction ofsystolic blood pressure (SBP) of about 10 mmHg to about 30 mmHg. In someembodiments, the treatment results in a reduction of systolic bloodpressure (SBP) of about 10 mmHg, about 11 mmHg, about 12 mmHg, about 13mmHg, about 14 mmHg, about 15 mmHg, about 16 mmHg, about 17 mmHg, about18 mmHg, about 19 mmHg, or about 20 mmHg. In some embodiments, thetreatment results in a reduction of systolic blood pressure (SBP) ofabout 10 mmHg, about 11 mmHg, about 12 mmHg, about 13 mmHg, about 14mmHg, about 15 mmHg, about 16 mmHg, about 17 mmHg, about 18 mmHg, about19 mmHg, about 20 mmHg, about 21 mmHg, about 22 mmHg, about 23 mmHg,about 24 mmHg, about 25 mmHg, about 26 mmHg, about 27 mmHg, about 28mmHg, about 29 mmHg, or about 30 mmHg. In some embodiments, thetreatment results in a diastolic blood pressure (DBP) of less than about90 mmHg. In some embodiments, the treatment results in a diastolic bloodpressure (DBP) of less than about 85 mmHg. In some embodiments,treatment results in a reduction of diastolic blood pressure (DBP) ofabout 5 mmHg or greater. In some embodiments, treatment results in areduction of diastolic blood pressure (DBP) of about 5 mmHg to about 10mmHg. In some embodiments, treatment results in a reduction of diastolicblood pressure (DBP) of about 5 mmHg to about 15 mmHg. In someembodiments, treatment results in a reduction of diastolic bloodpressure (DBP) of about 5 mmHg, about 6 mmHg, about 7 mmHg, about 8mmHg, about 9 mmHg, or about 10 mmHg. In some embodiments, treatmentresults in a reduction of diastolic blood pressure (DBP) of about 5mmHg, about 6 mmHg, about 7 mmHg, about 8 mmHg, about 9 mmHg, about 10mmHg, about 11 mmHg, about 12 mmHg, about 13 mmHg, about 14 mmHg, orabout 15 mmHg.

In some embodiments, treatment results in a reduction in systolic bloodpressure (SBP) that is greater than the reduction obtained with the fulllowest hypertension therapeutic dose of any one of the angiotensin IIreceptor blocker, the diuretic, and the calcium channel blocker in thepharmaceutical composition. In some embodiments, treatment results in areduction in systolic blood pressure (SBP) that is greater than thereduction obtained with the full lowest hypertension therapeutic dose ofthe angiotensin II receptor blocker in the pharmaceutical composition.In some embodiments, treatment results in a reduction in systolic bloodpressure (SBP) that is greater than the reduction obtained with the fulllowest hypertension therapeutic dose of the diuretic in thepharmaceutical composition. In some embodiments, treatment results in areduction in systolic blood pressure (SBP) that is greater than thereduction obtained with the full lowest hypertension therapeutic dose ofthe calcium channel blocker in the pharmaceutical composition.

In some embodiments, treatment results in a reduction in diastolic bloodpressure (DBP) that is greater than the reduction obtained with the fulllowest hypertension therapeutic dose of any one of the angiotensin IIreceptor blocker, the diuretic, and the calcium channel blocker in thepharmaceutical composition. In some embodiments, treatment results in areduction in diastolic blood pressure (DBP) that is greater than thereduction obtained with the full lowest hypertension therapeutic dose ofthe angiotensin II receptor blocker in the pharmaceutical composition.In some embodiments, treatment results in a reduction in diastolic bloodpressure (DBP) that is greater than the reduction obtained with the fulllowest hypertension therapeutic dose of the diuretic in thepharmaceutical composition. In some embodiments, treatment results in areduction in diastolic blood pressure (DBP) that is greater than thereduction obtained with the full lowest hypertension therapeutic dose ofthe calcium channel blocker in the pharmaceutical composition.

In some embodiments, treatment results in greater long term tolerabilityand reduced risk of side effects when compared to treatment with thefull lowest hypertension therapeutic dose of any one of the angiotensinII receptor blocker, the diuretic, and the calcium channel blocker inthe pharmaceutical composition. In some embodiments, the treatmentresults in greater long term tolerability and reduced risk of sideeffects when compared to treatment with the full lowest hypertensiontherapeutic dose of the angiotensin II receptor blocker in thepharmaceutical composition. In some embodiments, the treatment resultsin greater long term tolerability and reduced risk of side effects whencompared to treatment with the full lowest hypertension therapeutic doseof the diuretic in the pharmaceutical composition. In some embodiments,the treatment results in greater long term tolerability and reduced riskof side effects when compared to treatment with the full lowesthypertension therapeutic dose of the calcium channel blocker in thepharmaceutical composition.

In some embodiments, treatment results in a reduction in systolic bloodpressure (SBP) that is greater than or equal to the reduction obtainedwith the combination of any two of the angiotensin II receptor blocker,the diuretic, and the calcium channel blocker in the pharmaceuticalcomposition, wherein the dose of each angiotensin II receptor blocker,the diuretic, and the calcium channel blocker is about 50% of the lowesthypertension therapeutic dose. In some embodiments, treatment results ina reduction in diastolic blood pressure (DBP) that is greater than orequal to the reduction obtained with a combination of any two of theangiotensin II receptor blocker, the diuretic, and the calcium channelblocker in the pharmaceutical composition, wherein the dose of each theangiotensin II receptor blocker, the diuretic, and the calcium channelblocker is about 50% of the lowest hypertension therapeutic dose. Insome embodiments, the treatment results in greater long termtolerability and reduced risk of side effects when compared to treatmentwith a combination of any two of the angiotensin II receptor blocker,the diuretic, and the calcium channel blocker in the pharmaceuticalcomposition, wherein the dose of each the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is about 50% ofthe lowest hypertension therapeutic dose.

In some embodiments, the treatment is the initial or first-linetreatment of hypertension. In some embodiments, the subject has a verymild elevation of blood pressure prior to treatment. In someembodiments, the subject is not on any previous hypertension therapyprior to treatment. In some embodiments, the subject has a very mildelevation of blood pressure prior to treatment and is not on anyprevious hypertension therapy prior to treatment.

This present disclosure recognizes that the use of the angiotensin IIreceptor blocker in the pharmaceutical compositions disclosed herein insome embodiments provides beneficial therapeutic effects, which include,but are not limited to, significant reduction in blood pressure,significant reduction in blood pressure among subjects with mildelevation in blood pressure, greater long term tolerability, and reducedrisk of side effects. This present disclosure recognizes that theexclusion of a lipid-regulating agent, a platelet function-alteringagent, a serum homocysteine-lowering agent, or a combination thereof inthe pharmaceutical compositions disclosed herein in some embodimentsprovides beneficial therapeutic effects, which include, but are notlimited to, significant reduction in blood pressure, significantreduction in blood pressure among subjects with mild elevation in bloodpressure, greater long term tolerability, and reduced risk of sideeffects.

It is also recognized herein that in some embodiments, the triplecombination described herein comprising an angiotensin II receptorblocker, a diuretic, and a calcium channel blocker with each componentat about 40% to about 80% of the lowest hypertension therapeutic doseprovide significantly larger reductions in blood pressure (such assystolic blood pressure, diastolic blood pressure, or both) than atriple combination comprising angiotensin II receptor blocker (such aslosartan), a diuretic (such as hydrochlorothiazide), and a calciumchannel blocker (amlodipine besylate) with each component at 100% of thelowest hypertension therapeutic dose. In some embodiments, the triplecombination described herein comprising an angiotensin II receptorblocker, a diuretic, and a calcium channel blocker with each componentat about 40% to about 60% of the lowest hypertension therapeutic doseprovide significantly larger reductions in blood pressure (such assystolic blood pressure, diastolic blood pressure, or both) than atriple combination comprising angiotensin II receptor blocker (such aslosartan), a diuretic (such as hydrochlorothiazide), and a calciumchannel blocker (amlodipine besylate) with each component at 100% of thelowest hypertension therapeutic dose.

It is also recognized herein that in some embodiments, the triplecombination described herein comprising telmisartan, a thiazide-likediuretic, and a calcium channel blocker with each component at about 80%to about 150% of the lowest hypertension therapeutic dose providesignificantly larger reductions in blood pressure (such as systolicblood pressure, diastolic blood pressure, or both) than a triplecombination comprising losartan as angiotensin II receptor blocker, athiazide diuretic (such as hydrochlorothiazide), and a calcium channelblocker (amlodipine besylate). In some embodiments, the triplecombination described herein comprising telmisartan, a thiazide-likediuretic, and a calcium channel blocker with each component at about 80%to about 120% of the lowest hypertension therapeutic dose providesignificantly larger reductions in blood pressure (such as systolicblood pressure, diastolic blood pressure, or both) than a triplecombination comprising losartan as angiotensin II receptor blocker, athiazide diuretic (such as hydrochlorothiazide), and a calcium channelblocker (amlodipine besylate).

EXAMPLES Example 1: Cardiovascular Measurement in SpontaneouslyHypertensive Rats Receiving Combinations of Anti-Hypertensive Drugs

Summary

The purpose of this study was to evaluate the comparative effects onblood pressure of three different combinations of an angiotensin IIreceptor blocker, a calcium channel blocker, and a diuretic (a thiazidediuretic or a thiazide-like diuretic). The main objectives were toassess whether there were differences in the effects of combinationsutilizing different drugs from the same class, and differences betweencombinations utilizing the same drugs at different doses, including verylow doses (i.e., doses below the lowest doses approved and manufactured,such as those at 50% of the lowest hypertension therapeutic dose (LHTD).

The specific combinations studied were:

-   -   Combination 1: telmisartan, amlodipine besylate, and indapamide,        all at 50% of the lowest hypertension therapeutic dose (LHTD) or        one-quarter of the FDA recommended usual maintenance dose        (corresponds to telmisartan 10 mg, amlodipine besylate 1.25 mg,        and indapamide 0.625 mg);    -   Combination 2: telmisartan, amlodipine, and indapamide, all at        100% of the lowest hypertension therapeutic dose (LHTD) or        one-half of the FDA recommended usual maintenance dose        (corresponds to telmisartan 20 mg, amlodipine besylate 2.5 mg,        and indapamide 1.25 mg); and    -   Combination 3: losartan, amlodipine besylate, and        hydrochlorothiazide, all at 100% of the lowest hypertension        therapeutic dose (LHTD) or one-half of the FDA recommended usual        maintenance dose (corresponds to losartan 25 mg, amlodipine        besylate 2.5 mg, and hydrochlorothiazide 12.5 mg).

The study was conducted in spontaneously hypertensive rats (SHR), themost commonly-used animal model for the study of hypertension (See:Pinto Y M, Paul M, Ganten D. “Lessons from rat models of hypertensionfrom Goldblatt to genetic engineering”. Cardiovascular Research. 39 (1):77-88.). Drug doses were calculated using standard allometric scalingmethods and data from the published literature on C_(max) and AUC foreach of the six antihypertensive agents. Each animal was exposed to asingle dose of every drug combination in a Latin square design.

Methods

The following was used as the vehicle for the following study: 0.5%methylcellulose (w/v) and 0.25% polysorbate 80 (v/v) in 25 mM phosphatebuffer at pH 8+/−0.2.

The following animals were used in the study: Spontaneous Hypertensiverats (Strain: SHR/NCrl). The rats were obtained from Charles RiverLaboratories, Inc., Kingston, N.Y. The age at initiation of dosing wasat approximately 12 weeks. 13 male rats were used for acclimation. 8male rats were used for the study. The animals were identified by cagecard and tattoo.

Telemetry Implantation: The animals were implanted with Data ScienceInternational transmitters (HD-S10) for collection for blood pressureand heart rate data. The animals were not administered dose formulationsuntil at least 10 days after surgery.

Housing: The animals were individually housed in solid bottom cagesequipped with water bottles.

Diet: Teklad Global Diet—Rodent 2014 (Envigo RMS, Inc.) were provided adlibitum unless otherwise specified. In some instances, the animals werefed the meal-form of this diet if indicated by health conditions.

Water: Greenfield city water was provided ad libitum.

Contaminants: No known contaminants were present in the diet, water, orbedding (if applicable) at levels that would interfere with this study.

Environment: Environmental controls for the animal room were set tomaintain the following room conditions: a temperature range of 20 to 26°C., a relative humidity of 30 to 70%, and a 12-hour light/12-hour darkcycle.

Acclimation (Pre-dose Phase): The acclimation phase was for a maximum of1 week.

Environmental and Dietary Enrichments: The animals were given variouscage-enrichment devices and dietary enrichment (that do not requireanalyses).

Randomization: The animals were arbitrarily selected based on pre-dosephase mean arterial pressure values.

The following table shows the group designation of the rats used in thestudy:

TABLE 3 Number of Group Male Rats Day 1 Day 8 Day 15 Day 22 1 1Combination 1 Vehicle Combination 3 Combination 2 2 1 Combination 2Combination 3 Vehicle Combination 1 3 1 Combination 3 Combination 1Combination 2 Vehicle 4 1 Vehicle Combination 2 Combination 1Combination 3 5 1 Vehicle Combination 3 Combination 2 Combination 1 6 1Combination 3 Combination 1 Vehicle Combination 2 7 1 Combination 2Vehicle Combination 1 Combination 3 8 1 Combination 1 Combination 2Combination 3 Vehicle

The following table shows the dose levels administered in the study:

TABLE 4 Dose Dose Concen- Dose Level tration Volume Test Article(mg/kg/day) (mg/mL) (mL/kg) Combination Telmisartan 0.17 0.017 10 1Amlodipine Besylate 0.22 0.022 Indapamide 0.08 0.008 CombinationTelmisartan 0.34 0.034 10 2 Amlodipine Besylate 0.44 0.044 Indapamide0.16 0.016 Combination Amlodipine Besylate 0.44 0.044 10 3 LosartanPotassium 0.31 0.031 Hydrochlorothiazide 1.74 0.174 Vehicle 0.5%Methylcellulose 0 0 10 (w/v), 0.25% polysorbate 80 (v/v), in phosphatebuffer, pH 8 +/− 0.2

Dosing Procedures: For Combinations 1, 2 and 3, each test combinationformulation was prepared fresh on each day of dosing. A portion of thevehicle (approximately 80%) was added to the test combinationformulation and mixed until the preparations were homogenous. If ahomogenous suspension or solution was not obtained, 1N NaOH and/or 1NHCl was added to adjust to pH 9+0.2. The remainder of the vehicle addedand mixed with astir bar. The test combination formulations were stirredcontinuously at room temperature and protected from light forapproximately 30 minutes prior to and throughout dosing. The testcombination formulations were stored protected from light, stirring in arefrigerator set to maintain 2 to 8° C.

Dosing Procedures: For pre-dose handling, the test combinationformulations were allowed to equilibrate to approximately roomtemperature for at least 30 minutes prior to dosing. The animals weredosed at the volume of 10 mL/kg, and the actual dose volume was based onthe most recent body weight. Oral gavage was used to administer thedose. The dose interval was once daily on Days 1, 8, 15, and 22.Following dose administration, the remaining test combinationformulations were disposed of according to standard operatingprocedures.

Telemetry Collections: The animals were not disturbed or manipulatedimmediately prior to and during telemetry data collection without priorauthorization. Such disturbances include but were not limited to cagechanges, bedding changes, mopping, sanitation, or anything that woulddisturb the natural quiet environment that was important for collectionof the cardiovascular telemetry data

Animal Observation: Each rat was observed once daily in the morning. Anyabnormal findings were recorded. The rats were observed for mortality,abnormalities, and signs of pain or distress. Any abnormal findings thatwere observed during the unscheduled observation periods were alsonoted.

Body Weight: The body weights were obtained at least once during thepre-dose phase and prior to each scheduled dose. Additional body weightswere recorded to monitor animal health if appropriate. The animals wereinstrumented with a transmitter: a representative transmitter and leadswere used to tare the balance prior to the collection of body weightsfor dose calculation purposes.

Telemetry Data Collection: The arterial pressure raw signals weredigitized at a sampling rate of 500 Hz. Derived parameters in thepre-dose and dosing phases were the same. For pre-dose data collection,all implanted telemetry devices were checked for consistency of signaland to verify the telemetry signal was acceptable for analysis. Thesignal check consisted of at least one telemetry recording taken fromeach rat considered for the study. Telemetry data was recordedcontinuously for approximately 24 hours. The telemetry data was reviewedto determine if the rat was qualified for the study. The data wasmaintained in the study records and was used to calculate the nominal24-hour mean arterial pressure average to support the randomizationanimal selection. For dosing phase data collection, continuous telemetrydata was collected during the dosing phase starting at least 90 minutesprior to dosing through approximately 48 hours post-dose.

Nominal Dosing Time: The telemetry collection time points were based ona single nominal dosing time for all animals. The nominal dosing timefor each day of the dosing phase were the end of dosing for the firsthalf of animals dosed on that day recorded on each computer for allanimals on that compute.

Telemetry Data Evaluation: Telemetry parameters, including heart rate(beats/minute), systolic pressure (mmHg), diastolic pressure (mmHg),mean arterial pressure (mmHg), and arterial pulse pressure (mmHg), wereanalyzed and reported. Telemetry data generated by Ponemah during thedosing phases were analyzed in 1-minute samples. Data was processed in15-minute averages and were provided for data review. The 15-minute meandata was further averaged by binning into the following AnalysisPeriods:

-   -   Period 1: 0.5 to 2 hours post-dose;    -   Period 2: 2 to 4 hours post-dose;    -   Period 3: 4-8 hours post-dose;    -   Period 4: 8-12 hours post-dose;    -   Period 5: 12-20 hours post-dose;    -   Period 6: 20-32 hours post-dose (second light cycle); and    -   Period 7: 32 to 44 hours post-dose (second dark cycle).        Analysis

Blood pressure was measured over a 44-hour period using an implantedtelemetry device. The primary outcome was systolic blood pressure.

Statistical analyses were conducted using all available data points,with weighting to reflect the non-uniform timing of measurements.Estimates of treatment effects were calculated using estimateddifferences between treatments using a mixed model (SAS 9.4, SASInstitute, Cary, N.C.) with a direct product autoregressive correlationstructure to account for repeated measurements within individuals overtime.

Results

Eight animals began the study; however, the telemetry transmitter failedin one animal. As a result, complete data was available from sevenanimals.

The following table shows the differences in systolic BP (mmHg) betweentreatments:

TABLE 5 Comparison Level Estimate (95% CI) P-value Overall difference0.0004 between treatments Systolic BP (95% Control 177.4 (174.4-180.3) —CI) Combination 1 172.1 (169.3-174.9) — Combination 2 169.0(166.1-171.9) — Combination 3 175.4 (172.5-178.3) — Treatment Control vs−5.3 (−8.7-1.8) 0.0048 comparisons Combination 1 Control vs −8.4(−11.5-5.2) <.0001 Combination 2 Control vs −2.0 (−5.6-1.7) 0.2663Combination 3 Combination 1 vs −3.1 (−6.5-0.3) 0.0720 Combination 2Combination 1 vs 3.3 (0.3-6.3) 0.0342 Combination 3 Combination 2 vs 6.4(3.0-9.8) 0.0009 Combination 3

FIG. 1 shows the mean systolic blood pressure (mmHg) across time periodsby treatment. FIG. 2 shows the mean diastolic blood pressure (mmHg)across time periods by treatment. FIG. 3 shows the mean heart rateacross time periods by treatment.

In this non-limiting example, the results demonstrated that Combination1 produced significantly larger reductions in systolic blood pressurethan Combination 3, and Combination 2 produced significantly largerreductions in systolic blood pressure than either Combination 3 or 1.These differences persisted over the full 44-hour period of observation.The results demonstrated that both Combination 1 and Combination 2produced significantly larger reductions in systolic blood pressure thanCombination 3. These differences persisted over the full 44-hour periodof observation. There were similar differences between the threecombinations in the reduction in DPB, and no differences between thecombinations in heart rate.

In this non-limiting example, these results demonstrate unexpecteddifferences between the telmisartan, amlodipine besylate, indapamidecombinations and the losartan, amlodipine besylate, hydrochlorothiazidecombination. Specifically, at equivalent or lower doses, thetelmisartan, amlodipine besylate, and indapamide combination producedsignificantly larger reductions in blood pressure than the combinationof losartan, amlodipine besylate, and hydrochlorothiazide. As theamlodipine besylate dose was the same in Combination 2 and 3, theresults demonstrate previously unknown differences in the effectivenessof specific angiotensin II receptor blockers and specific diuretics(such as a thiazide diuretic versus a thiazide-like diuretic) whenprovided in parallel with amlodipine besylate.

Example 2: Triple Combination Composition Therapy for the Treatment ofHypertension

Methods

This study is a randomized, placebo-controlled, double-blind cross-overtrial. The study is divided into three phases. During the first phase (4weeks) participants are randomized (1:1) to either receive the triplecombination composition therapy or Placebo. This is followed by a twoweek washout (placebo) and subsequently participants are crossed over tothe opposite arm to receive the other treatment for four weeks.Participants are recruited from the community, predominantly throughcommunity general practices in western Sydney, Australia.

Participants

Participants are eligible if they met the following inclusioncriteria: 1) adults aged 18 years and over, 2) office SBP>140 mmHgand/or DBP>90 mmHg on 2 readings on separate days; plus baselineambulatory SBP>135 and/or DBP>85; 3) Not on medical treatment forhypertension. Exclusion criteria included: No definite contraindicationto one or more component medications in the triple combinationcomposition; the responsible clinician felt a change in current therapywould place the patient at risk; severe or accelerated hypertension;pregnancy; inability to provide informed consent; and medical illnesswith anticipated life expectancy less than 3 months.

Intervention

For these studies, either the triple combination with each component at50% of the lowest hypertension therapeutic dose (LHTD) or the triplecombination with each component at 100% of the lowest hypertensiontherapeutic dose (LHTD) will be tested.

If the study is testing the triple combination with each component at50% of the lowest hypertension therapeutic dose (LHTD), then the testcomposition is as follows. The triple combination composition is asingle encapsulated pill containing the three following components inthe specified amounts: telmisartan 10 mg, amlodipine besylate 1.25 mg,and indapamide 0.625 mg. The placebo capsule appears identical andcontains placebo tablets of similar weight to those in the triplecombination composition.

If the study is testing the triple combination with each component at100% of the lowest hypertension therapeutic dose (LHTD), then the testcompositions is as follow. The triple combination composition is asingle encapsulated pill containing the three following components inthe specified amounts: telmisartan 20 mg, amlodipine besylate 2.5 mg,and indapamide 1.25 mg. The placebo capsule appears identical andcontains placebo tablets of similar weight to those in the triplecombination composition.

Participants are administered a single pill, triple combinationcomposition or placebo, throughout the trial. Patients are instructed totake the tablets at the same time each day and are encouraged to takethis in the morning, but the time of the day (morning or evening) is atthe patient's preference.

All trial medicines are prepared by a TGA-cGMP (Therapeutic GoodsAustralia-certificate of Good Manufacturing Practice) licensedmanufacturing facility. If appropriate, low strength doses are obtainedby halving half-strength doses using a pill splitting device, withoutcrushing, and are weighed to ensure accuracy of halving doses. The lowstrength doses are than encapsulated using gelatin capsules(DBCaps-Capsugel). The capsules are stored in a cool dry place andmonitored using temperature loggers, until they are dispensed.

Treatment allocations are blinded to both study staff and participants.In addition to the study drugs, all participants are offered educationon healthier lifestyle options as recommended by guidelines forhypertension management.

Randomization

A computer assisted randomization sequence is generated by astatistician and supplied to the pharmaceutical packaging company. Theresearch assistant, recruitment team, investigators are blinded to thissequence. For each patient i.e. allocated randomization number, thepills are packaged into three child-resistant packs corresponding tothree phases of the study. All packs have identical appearance ensuringblinding of patient and research staff. Subsequently the medicationpacks are prescribed in an organized sequence.

Outcomes and Data Collection

The primary outcome is reduction in mean 24 hour systolic blood pressureat 4 weeks using ambulatory blood pressure monitoring (ABP). Thesecondary outcomes include:

-   -   a. Reduction in mean 24 hour diastolic blood pressure, and in        daytime and nighttime SBP and DBP at 4 weeks    -   b. Reduction in office SBP and DBP as measured by a standardized        automated blood pressure cuff    -   c. Proportion with controlled blood pressure at 4 weeks, defined        as <135/85 mmHg 24 hour BP and <140/90 mmHg office BP    -   d. Adverse events and pre-specified adverse events by laboratory        parameters: Rise in transaminases (ALT/AST) more than 3× upper        limit of normal or doubling if baseline levels known to be        elevated; drop in estimated glomerular filtration rate by >20%        as estimated from serum creatinine; sodium, potassium and uric        acid levels    -   e. Assessment of acceptability and tolerability

Patients will undergo 24 hour ABP monitoring 4 times—baseline (off studydrug), 4 weeks (on phase 1 drug), 6 weeks (on placebo), and 10 weeks (onphase 3 drug). In order to minimize inconvenience, patients are referredfor ABP to a lab. The ABP units are calibrated at regular intervals bythe lab according to the manufacturer's specification. To minimizevariability, the follow up readings are repeated from the samecollection center using the same brand device. Participants arereimbursed nominal amounts to cover travel and parking costs. Studymedications and investigations are provided at no cost to participants.Office BP is recorded three times at each visit using an OMRON T9P(HEM-759-C1). The second and the third readings are averaged for studyanalysis. In addition at week 4 and 10 patients will undergo blood teststo assess for biochemical side effects, are administered a questionnairefor clinical side effects, and compliance is assessed by self-report andpill count. Patients will remain blinded to their treatment allocationwhen completing this questionnaire.

Drug acceptability and tolerability are also assessed at the end of thestudy. All adverse events are recorded. In addition, clinical adverseevents possibly associated with blood pressure lowering medications:dizziness, blurred vision, syncope/collapse, chest pain/angina,shortness of breath, cough, wheeze, pedal oedema, skin rash, itching arespecifically asked about.

The trial has a simplified data safety and management committee of twocore members with expertise in clinical medicine, trials and statistics.A single meeting convenes when 10 patients are randomized to the trialto review safety, and the study is advised to continue.

Statistical Considerations

A sample size of 50 patients is planned to provide 90% power at p=0.05to detect a SBP difference of 12 mmHg between the intervention andcontrol assuming a SD of the within patient difference of 12 mmHg,taking into account the possibility of a 10% loss to follow-up.

Statistical Approach

Analyses are conducted on an intention to treat basis. All tests aretwo-sided and the nominal level of α is 5%. All statistical analyses areunadjusted for prognostic covariates. We will report compliance to thestudy drug using data on pills (doses) taken and missed doses over thetime period.

A linear mixed model is used to estimate the effect of the treatment onchange in blood pressure from baseline for each treatment period,according to the Kenward and Roger approach (Kenward M G, Roger J H. Theuse of baseline covariates in crossover studies. Biostatistics 2010;11(1): 1-17.) In order to appropriately adjust for baseline levels,collected at the beginning of each treatment period (week 0, week 6),this method uses all measurements (baseline and follow-up, in bothperiod) as outcomes, but accounts for covariance between measurementswithin individuals (Liu G F, Lu K, Mogg R, Mallick M, Mehrotra D V.Should baseline be a covariate or dependent variable in analyses ofchange from baseline in clinical trials? Stat Med 2009; 28(20):2509-30). A linear contrast between the variables denoting period(first/second), type of measurement (baseline/final), and treatmentreceived (placebo/triple combination composition) produces an unbiasedestimate of effect of the triple combination composition on change inblood pressure compared to the placebo. All available data are includedin the model, no missing data is imputed. If a patient is missing datafor one period, data from the available period are used. A sensitivityanalysis is carried including only patients with data available fromboth periods to see if the effect of treatment is modified. There isalso adjustment of the denominator degrees of freedom of Kenward andRoger (2009) that is optimal for smaller sample sizes (Kenward M G,Roger J H. An improved approximation to the precision of fixed effectsfrom restricted maximum likelihood. Computational Statistics & DataAnalysis 2009; 53(7): 2583-95).

Testing for carry over will use an unpaired t-test of the main outcomewith order as an effect. Period effect is tested by using a pairedt-test comparing the main outcome in period 1 with main outcome inperiod 2 from the same patient. A sensitivity analysis is also performedusing normal paired t-test to compare primary outcome between differentperiod (different treatment) from the same patient, ignoring thebaseline level of each period.

Continuous secondary endpoints with baseline values (e.g.,daytime/night-time ambulatory SBP/DBP) are analyzed similarly to theprimary endpoint. Other continuous variables without a baseline value ineach period are analyzed with a paired t-test. Counts and percentages ofall adverse events are reported. As a sensitivity analysis, the analysesare repeated on the complete cases (i.e. full data for each measurementperiod).

Tests for interaction of treatment effect with age (<=60 vs. >60 years),gender, and BMI (<=30 vs. <30 kg/m²). Subgroup analyses for eachvariable are also conducted. All analyses are conducted using SAS 9.4(Cary, N.C., USA) on software.

Example 3: Comparative Study of Triple Combination Versus Standard DoseMonotherapy for the Treatment of Hypertension

Objectives

The primary objective of this study is to investigate in a double blindrandomized controlled trial whether initiating treatment with a triplecombination therapy will lower blood pressure more effectively, and withfewer side effects, compared to initiating standard dose monotherapy asper current guidelines in patients with hypertension. The secondaryobjective is to assess if this approach is safe and has fewer sideeffects compared to standard care.

Study Design

This will be a 12-week double blind randomized controlled trial (1:1) of650 patients with grade 1 and 2 essential hypertension. Subjects will berandomized through a central computer-based randomization service, toinitial therapy with the triple combination composition or to anangiotensin receptor blocker (ARB), with option to add a calcium channelblocker (CCB) as required, as per current Australian Hypertensionguidelines. The primary outcome will be reduction in mean systolic bloodpressure using standardized automated BP cuff at 12 weeks. Secondaryoutcomes will include: proportion with controlled blood pressure at 6weeks, 12 weeks, ambulatory blood pressure (ABP) measures andtolerability/occurrence of adverse events.

Eligibility Criteria

The inclusion criteria are as follows:

Adults (≥18 years)

Treatment nave, or currently not on treatment (not taken in last 4weeks), or taking one BP lowering drug (angiotensin converting enzymeinhibitor, angiotensin receptor blocker, calcium channel blocker,beta-blocker, aldosterone antagonist, alpha-blocker)

SBP 140-179 mmHg and/or DBP 90-109 mmHg documented on two occasions morethan a week apart

At least one of the measures should be documented by study staff withstudy automatic BP device OR recorded as daytime average SBP≥135 mmHgand/or DBP≥85 mmHg on 24 hour ambulatory BP monitoring

At least one of these measures should be recent (in last 12 weeks)

24 hour Ambulatory BP monitoring daytime average SBP≥135 mmHg and/orDBP≥85 mmHg—documented within 12 weeks of randomization

The exclusion criteria are as follows:

Contraindication to telmisartan, amlodipine, or indapamide

Evidence of secondary cause of hypertension e.g. renal artery stenosis;Significant renal impairment (eGRF<50), raised serum potassium (abovelab normal limit)

Women who are pregnant, breast feeding and/or of childbearing potentialand not using medically acceptable form of contraception throughout thestudy (pharmacological or barrier methods)

Concomitant illness, physical impairment or mental condition which inthe opinion of the study team/primary care physician could interferewith the conduct of the study including outcome assessments

Participation in a concurrent interventional medical investigation orclinical trial. Patients in observational, natural history and/orepidemiological studies not involving an intervention are eligible.

Participant's responsible primary care or other responsible physicianbelieves it is not appropriate for participant to switch currentmonotherapy

Inability or unwillingness to provide written informed consent

Unable to complete study procedures including 24 hour Ambulatory BP

Definite indication for combination therapy

Study Treatment

For these studies, either the triple combination with each component at50% of the lowest hypertension therapeutic dose (LHTD) or the triplecombination with each component at 100% of the lowest hypertensiontherapeutic dose (LHTD) will be tested.

If the study is testing the triple combination with each component at50% of the lowest hypertension therapeutic dose (LHTD), then the testcomposition is as follows. Patients who meet criteria for inclusion willbe randomized to: 1) A combination pill comprising the following threecomponents—telmisartan 10 mg, amlodipine besylate 1.25 mg, andindapamide 0.625 mg; or 2) telmisartan 40 mg.

If the study is testing the triple combination with each component at100% of the lowest hypertension therapeutic dose (LHTD), then the testcomposition is as follows. Patients who meet criteria for inclusion willbe randomized to: 1) A combination pill comprising the following threecomponents—telmisartan 20 mg, amlodipine besylate 2.5 mg, and indapamide1.25 mg; or 2) telmisartan 40 mg.

Patients who are currently on monotherapy will be asked to stop theirtreatment while they are taking the study treatment. At 6 weeks if theBP is greater than 140/90 mmHg in either arm amlodipine besylate (5 mg)will be added by study staff.

Outcomes

The primary outcome will be the difference between groups in meanautomated office systolic blood pressure at 12 weeks adjusted forbaseline values.

The secondary outcomes include the following:

The 24-hour ambulatory blood pressure measures

-   -   a. Difference between groups in mean 24-hour SBP and DBP at 12        weeks    -   b. Difference between groups in mean change in 24-hour SBP and        DBP from 0 to 12 weeks    -   c. Difference between groups in mean daytime SBP and DBP at 12        weeks Difference between groups in mean night-time SBP and DBP        at 12 weeks    -   d. Difference between groups in daytime, night-time, and 24 hour        BP load (percentage area under the blood pressure curve above        normal day, night, and 24 hour values as per NHFA Guide to        management of hypertension 2008)    -   e. Difference between groups in the proportion of non-dippers        (night-time BP is not more than 10% lower than average daytime        BP as per NHFA Guide to management of hypertension 2008) and        coefficient of variability of BP (O'Brien, E., G. Parati, and G.        Stergiou, Hypertension, 2013. 62(6): p. 988-94).

Other blood pressure measures in the triple group vs control groups:

-   -   a. Change in mean diastolic blood pressure from baseline to 12        weeks,    -   b. Hypertension control (% with SBP<140 mmHg and DBP<90 mmHg) at        6 and 12 weeks,    -   c. Percentage requiring step-up treatment at 6 weeks    -   d. Percentage with both BP control (as defined above) and no        adverse events.    -   e. Difference between groups in SBP and DBP variability

Tolerability

-   -   a. Difference between groups in potentially related side-effects        (dizziness, blurred vision, syncope/collapse/fall, chest        pain/angina, shortness of breath, cough, wheeze, ankle oedema,        skin rash, itching, gout, hyperkalaemia, hypokalaemia,        hyponatraemia, other)    -   b. Difference between groups in mean potassium, uric acid, blood        glucose, cholesterol and fractions, ALT, AST, UACR (Urine        albumin-to-creatinine ratio) and creatinine levels.    -   c. Difference between groups in participant withdrawals from        treatment        Statistical Methods

All analyses of study outcomes will be conducted according to theprinciple of intention-to-treat. The primary analysis of change insystolic blood pressure (SBP) at 12 weeks will be performed using ananalysis of covariance (ANCOVA) including the treatment arm and baselineSBP as a covariate. Continuous secondary outcomes will be analyzedsimilarly. Additional analyses will include both 6-week and 12-weekmeasurements in a longitudinal model including treatment arm, visit, andtreatment by visit interaction as well as the baseline measurement.Within-patient correlations will be modelled using generalizedestimating equations. A similar approach will be applied to binaryendpoints (e.g. hypertension control) with log-binomial regression usedin place of linear regression. There will also be pre-defined subgroupanalyses, including by baseline blood pressure, gender, age, andhypertension treatment history. A detailed analysis plan will bedeveloped prior to unblinding.

Example 4: Pharmaceutical Compositions 1

The following pharmaceutical compositions are prepared with thespecified components and doses as shown in the following table.

TABLE 6 Proposed Proposed Dose Agent Dose (mg) Range (mg) Composition AAmlodipine besylate 1.25 1-1.5 Hydrochlorothiazide 6.25 5-7.5Telmisartan 10 8-12  Composition B Amlodipine besylate 1.25 1-1.5Indapamide 0.625 0.5-0.75  Telmisartan 10 8-12  Composition C Amlodipinebesylate 1.25 1-1.5 Chlorthalidone 12.5 10-15  Telmisartan 10 8-12 Composition D Amlodipine besylate 1.25 1-1.5 Chlorthalidone 12.5 10-15 Irbesartan 37.5 30-45 

Example 5: Pharmaceutical Compositions 2

The following pharmaceutical compositions are prepared with thespecified components and doses as shown in the following table.

TABLE 7 Proposed Proposed Dose Agent Dose (mg) Range (mg) Composition EAmlodipine besylate 1.65 1.5-2  Hydrochlorothiazide 8.25 7.5-10 Irbesartan 49.5 45-60 Composition F Amlodipine besylate 1.65 1.5-2 Indapamide 0.825 0.75-1.0  Irbesartan 49.5 45-60 Composition GAmlodipine besylate 1.65 1.5-2  Hydrochlorothiazide 8.25 7.5-10 Telmisartan 13.2 12-16 Composition H Amlodipine besylate 1.65 1.5-2 Indapamide 0.825 0.75-1.0  Telmisartan 13.2 12-16 Composition IAmlodipine besylate 1.65 1.5-2  Chlorthalidone 16.5 15-20 Telmisartan13.2 12-16 Composition J Amlodipine besylate 1.65 1.5-2  Chlorthalidone16.5 15-20 Irbesartan 49.5 45-60

Example 6: Pharmaceutical Compositions 3

The following pharmaceutical compositions are prepared with thespecified components and doses as shown in the following table.

TABLE 8 Proposed Proposed Dose Agent Dose (mg) Range (mg) Composition KAmlodipine besylate 2.5 2-3.75 Hydrochlorothiazide 12.5 10-18.75Irbesartan 75 60-112.5 Composition L Amlodipine besylate 2.5 2-3.75Indapamide 1.25  1-1.875 Irbesartan 75 60-112.5 Composition M Amlodipinebesylate 2.5 2-3.75 Hydrochlorothiazide 12.5 10-18.75 Telmisartan 2016-30   Composition N Amlodipine besylate 2.5 2-3.75 Indapamide 1.25 1-1.875 Telmisartan 20 16-30   Composition O Amlodipine besylate 2.52-3.75 Chlorthalidone 25 20-37.5  Telmisartan 20 16-30   Composition PAmlodipine besylate 2.5 2-3.75 Chlorthalidone 25 20-37.5  Irbesartan 7560-112.5

Embodiments

Embodiment 1. A pharmaceutical composition comprising

-   -   (a) an angiotensin II receptor blocker;    -   (b) a diuretic; and    -   (c) a calcium channel blocker        wherein the dose of each (a), (b), and (c) is from about 40% to        about 80% of the lowest hypertension therapeutic dose (LHTD) for        each of the (a), (b), and (c).

Embodiment 2. The pharmaceutical composition of embodiment 1, whereinthe pharmaceutical composition comprises a blood pressure loweringcombination of blood pressure lowering active agents, wherein the bloodpressure lowering active agents consists of an angiotensin II receptorblocker, a diuretic, and a calcium channel blocker.

Embodiment 3. The pharmaceutical composition of embodiments 1 or 2,wherein the pharmaceutical composition is essentially free of anangiotensin-converting enzyme inhibitor or a pharmaceutically acceptablesalt thereof.

Embodiment 4. The pharmaceutical composition of any one of embodiments1-3, wherein the pharmaceutical composition is essentially free of abeta-blocker or a pharmaceutically acceptable salt thereof.

Embodiment 5. The pharmaceutical composition of any one of embodiments1-4, wherein the pharmaceutical composition is essentially free of alipid-regulating agent, platelet function-altering agent, a serumhomocysteine-lowering agent, or a combination thereof.

Embodiment 6. The pharmaceutical composition of embodiment 5, whereinthe pharmaceutical composition is essentially free of a lipid-regulatingagent.

Embodiment 7. The pharmaceutical composition of embodiment 6, whereinthe lipid-regulating agent is atorvastatin, simvastatin, cerivastatin,fluvastatin, or pravastatin.

Embodiment 8. The pharmaceutical composition of embodiments 6 or 7,wherein the lipid-regulating agent is atorvastatin or simvastatin.

Embodiment 9. The pharmaceutical composition of embodiment 5, whereinthe pharmaceutical composition is essentially free of a plateletfunction-altering agent.

Embodiment 10. The pharmaceutical composition of embodiment 9, whereinthe platelet function-altering agent is aspirin, ticlopidine,dipyridamole, clopidogrel, abciximab, or ibuprofen.

Embodiment 11. The pharmaceutical composition of embodiments 9 or 10,wherein the platelet function-altering agent is aspirin.

Embodiment 12. The pharmaceutical composition of embodiment 5, whereinthe pharmaceutical composition is essentially free of a serumhomocysteine-lowering agent.

Embodiment 13. The pharmaceutical composition of embodiment 12, whereinthe serum homocysteine-lowering agent is folic acid, vitamin B6, vitaminB12, or a combination thereof.

Embodiment 14. The pharmaceutical composition of embodiments 12 or 13,wherein the serum homocysteine-lowering agent is folic acid.

Embodiment 15. The pharmaceutical composition of any one of embodiments1-14, wherein the diuretic is a thiazide diuretic.

Embodiment 16. The pharmaceutical composition of embodiment 15, whereinthe thiazide diuretic is altizide, bendroflumethiazide, chlorothiazide,cyclopenthiazide, cyclothiazide, epitizide, hydrochlorothiazide,hydroflumethiazide, mebutizide, methyclothiazide, polythiazide,trichlormethiazide, or the pharmaceutically acceptable salt or hydratethereof.

Embodiment 17. The pharmaceutical composition of embodiment 16, whereinthe thiazide diuretic is hydrochlorothiazide.

Embodiment 18. The pharmaceutical composition of any one of embodiments1-14, wherein the diuretic is a thiazide-like diuretic.

Embodiment 19. The pharmaceutical composition of embodiment 18, whereinthe thiazide-like diuretic is quinethazone, clopamide, chlorthalidone,mefruside, clofenamide, metolazone, meticrane, xipamide, indapamide,clorexolone, fenquizone, or the pharmaceutically acceptable salt orhydrate thereof.

Embodiment 20. The pharmaceutical composition of embodiment 19, whereinthe thiazide-like diuretic is indapamide or the hydrate thereof.

Embodiment 21. The pharmaceutical composition of embodiment 20, whereinthe thiazide-like diuretic is indapamide.

Embodiment 22. The pharmaceutical composition of embodiment 19, whereinthe thiazide-like diuretic is chlorthalidone.

Embodiment 23. The pharmaceutical composition of any one of embodiments1-14, wherein the diuretic is a loop diuretic.

Embodiment 24. The pharmaceutical composition of embodiment 23, whereinthe loop diuretic is furosemide, bumetanide, etacrynic acid, etozolin,muzolimine, ozolinone, piretanide, tienilic acid, torasemide, or thepharmaceutically acceptable salt or hydrate thereof.

Embodiment 25. The pharmaceutical composition of any one of embodiments1-14, wherein the diuretic is dichlorphenamide, amiloride, pamabrom,mannitol, acetazolamide, methazolamide, spironolactone, triamterene, orthe pharmaceutically acceptable salt or hydrate thereof.

Embodiment 26. The pharmaceutical composition of any one of embodiments1-25, wherein the calcium channel blocker is amlodipine, nifedipine,diltiazem, nimodipine, verapamil, isradipine, felodipine, nicardipine,nisoldipine, clevidipine, dihydropyridine, lercanidipine, nitrendipine,cilnidipine, manidipine, mibefradil, bepridil, barnidipine, nilvadipine,gallopamil, lidoflazine, aranidipine, dotarizine, diproteverine, or thepharmaceutically acceptable salt or hydrate thereof.

Embodiment 27. The pharmaceutical composition of embodiment 26, whereinthe calcium channel blocker is amlodipine or the pharmaceuticallyacceptable salt thereof.

Embodiment 28. The pharmaceutical composition of embodiment 27, whereinthe calcium channel blocker is amlodipine besylate.

Embodiment 29. The pharmaceutical composition of any one of embodiments1-28, wherein the angiotensin II receptor blocker is irbesartan,telmisartan, valsartan, candesartan, eprosartan, olmesartan, azilsartan,losartan, or the pharmaceutically acceptable salt or hydrate thereof.

Embodiment 30. The pharmaceutical composition of embodiment 29, whereinthe angiotensin II receptor blocker is irbesartan.

Embodiment 31. The pharmaceutical composition of embodiment 29, whereinthe angiotensin II receptor blocker is telmisartan.

Embodiment 32. The pharmaceutical composition of any one of embodiments1-31, wherein the dose of each (a), (b), and (c) is from about 40% toabout 60% of the lowest hypertension therapeutic dose (LHTD) for each ofthe (a), (b), and (c).

Embodiment 33. The pharmaceutical composition of embodiment 32, whereinthe diuretic is a thiazide diuretic, and the dose of the thiazidediuretic is about 50% of the lowest hypertension therapeutic dose (LHTD)for the thiazide diuretic.

Embodiment 34. The pharmaceutical composition of embodiment 33, whereinthe thiazide diuretic is hydrochlorothiazide, and the dose of thehydrochlorothiazide is about 6.25 mg.

Embodiment 35. The pharmaceutical composition of embodiment 32, whereinthe diuretic is a thiazide-like, and the dose of the thiazide-likediuretic is about 50% of the lowest hypertension therapeutic dose (LHTD)for the thiazide-like diuretic.

Embodiment 36. The pharmaceutical composition of embodiment 35, whereinthe thiazide-like diuretic is indapamide, and the dose of the indapamideis about 0.625 mg.

Embodiment 37. The pharmaceutical composition of embodiment 35, whereinthe thiazide-like diuretic is chlorthalidone, and the dose of thechlorthalidone is about 12.5 mg.

Embodiment 38. The pharmaceutical composition of embodiment 32, whereinthe diuretic is a loop diuretic, and the dose of the loop diuretic isabout 50% of the lowest hypertension therapeutic dose (LHTD) for theloop-diuretic.

Embodiment 39. The pharmaceutical composition of any one of embodiments32-38, wherein the dose of the calcium channel blocker is about 50% ofthe lowest hypertension therapeutic dose (LHTD) for the calcium channelblocker.

Embodiment 40. The pharmaceutical composition of embodiment 39, whereinthe calcium channel blocker is amlodipine besylate, and the dose ofamlodipine besylate is about 1.25 mg.

Embodiment 41. The pharmaceutical composition of anyone of embodiments32-40, wherein the dose of the angiotensin II receptor blocker is about50% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker.

Embodiment 42. The pharmaceutical composition of embodiment 41, whereinthe angiotensin II receptor blocker is irbesartan, and dose of theirbesartan is about 37.5 mg.

Embodiment 43. The pharmaceutical composition of embodiment 41, whereinthe angiotensin II receptor blocker is telmisartan, and the dose of thetelmisartan is about 10 mg.

Embodiment 44. The pharmaceutical composition of embodiment 32, whereinthe angiotensin II receptor blocker is irbesartan, the diuretic ishydrochlorothiazide, and the calcium channel blocker is amlodipinebesylate.

Embodiment 45. The pharmaceutical composition of embodiment 44, whereinthe dose of irbesartan is from about 30 mg to about 45 mg, the dose ofhydrochlorothiazide is from about 5 mg to about 7.5 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg.

Embodiment 46. The pharmaceutical composition of embodiment 45, whereinthe dose of irbesartan is about 37.5 mg, the dose of hydrochlorothiazideis about 6.25 mg, and the dose of amlodipine besylate is about 1.25 mg.

Embodiment 47. The pharmaceutical composition of embodiment 32, whereinthe angiotensin II receptor blocker is telmisartan, the diuretic ishydrochlorothiazide, and the calcium channel blocker is amlodipinebesylate.

Embodiment 48. The pharmaceutical composition of embodiment 47, whereinthe dose of telmisartan is from about 8 mg to about 12 mg, the dose ofhydrochlorothiazide is from about 5 mg to about 7.5 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg.

Embodiment 49. The pharmaceutical composition of embodiment 48, whereinthe dose of telmisartan is about 10 mg, the dose of hydrochlorothiazideis about 6.25 mg, and the dose of amlodipine besylate is about 1.25 mg.

Embodiment 50. The pharmaceutical composition of embodiment 32, whereinthe angiotensin II receptor blocker is irbesartan, the diuretic isindapamide, and the calcium channel blocker is amlodipine besylate.

Embodiment 51. The pharmaceutical composition of embodiment 50, whereinthe dose of irbesartan is from about 30 mg to about 45 mg, the dose ofindapamide is from about 0.5 mg to about 0.75 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg.

Embodiment 52. The pharmaceutical composition of embodiment 51, whereinthe dose of irbesartan is about 37.5 mg, the dose of indapamide is about0.625 mg, and the dose of amlodipine is about 1.25 mg.

Embodiment 53. The pharmaceutical composition of embodiment 32, whereinthe angiotensin II receptor blocker is telmisartan, the diuretic isindapamide, and the calcium channel blocker is amlodipine besylate.

Embodiment 54. The pharmaceutical composition of embodiment 53, whereinthe dose of telmisartan is from about 8 mg to about 12 mg, the dose ofindapamide is from about 0.5 mg to about 0.75 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg.

Embodiment 55. The pharmaceutical composition of embodiment 54, whereinthe dose of telmisartan is about 10 mg, the dose of indapamide is about0.625 mg, and the dose of amlodipine besylate is about 1.25 mg.

Embodiment 56. The pharmaceutical composition of embodiment 32, whereinthe angiotensin II receptor blocker is telmisartan, the diuretic ischlorthalidone, and the calcium channel blocker is amlodipine besylate.

Embodiment 57. The pharmaceutical composition of embodiment 56, whereinthe dose of telmisartan is from about 8 mg to about 12 mg, the dose ofchlorthalidone is from about 10 mg to about 15 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg.

Embodiment 58. The pharmaceutical composition of embodiment 57, whereinthe dose of telmisartan is about 10 mg, the dose of chlorthalidone isabout 12.5 mg, and the dose of amlodipine besylate is about 1.25 mg.

Embodiment 59. The pharmaceutical composition of embodiment 32, whereinthe angiotensin II receptor blocker is irbesartan, the diuretic ischlorthalidone, and the calcium channel blocker is amlodipine besylate.

Embodiment 60. The pharmaceutical composition of embodiment 59, whereinthe dose of irbesartan is from about 30 mg to about 45 mg, the dose ofchlorthalidone is from about 10 mg to about 15 mg, and the dose ofamlodipine besylate is from about 1 mg to about 1.5 mg.

Embodiment 61. The pharmaceutical composition of embodiment 60, whereinthe dose of irbesartan is about 37.5 mg, the dose of chlorthalidone isabout 12.5 mg, and the dose of amlodipine besylate is about 1.25 mg.

Embodiment 62. The pharmaceutical composition of any one of embodiments1-31, wherein the dose of each (a), (b), and (c) is from about 60% toabout 80% of the lowest hypertension therapeutic dose (LHTD) for each ofthe (a), (b), and (c).

Embodiment 63. The pharmaceutical composition of embodiment 62, whereinthe diuretic is thiazide diuretic, and dose of the thiazide diuretic isabout 66% of the lowest hypertension therapeutic dose (LHTD) for thethiazide diuretic.

Embodiment 64. The pharmaceutical composition of embodiment 63, whereinthe thiazide diuretic is hydrochlorothiazide, and the dose of thehydrochlorothiazide is about 8.25 mg.

Embodiment 65. The pharmaceutical composition of embodiment 62, whereinthe diuretic is thiazide-like diuretic, and dose of the thiazide-likediuretic is about 66% of the lowest hypertension therapeutic dose (LHTD)for the thiazide-like diuretic.

Embodiment 66. The pharmaceutical composition of embodiment 65, whereinthe thiazide-like diuretic is indapamide, and the dose of the indapamideis about 0.825 mg.

Embodiment 67. The pharmaceutical composition of embodiment 65, whereinthe thiazide-like diuretic is chlorthalidone, and the dose of thechlorthalidone is about 16.5 mg.

Embodiment 68. The pharmaceutical composition of embodiment 62, whereinthe diuretic is loop diuretic, and the dose of the loop diuretic isabout 66% of the lowest hypertension therapeutic dose (LHTD) for theloop-diuretic.

Embodiment 69. The pharmaceutical composition of any one of embodiments62-68, wherein the dose of the calcium channel blocker is about 66% ofthe lowest hypertension therapeutic dose (LHTD) for the calcium channelblocker.

Embodiment 70. The pharmaceutical composition of embodiment 69, whereinthe calcium channel blocker is amolodipine besylate and dose ofamlodipine besylate is about 1.65 mg.

Embodiment 71. The pharmaceutical composition of any one of embodiments62-70, wherein the dose of the angiotensin II receptor blocker is about66% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker.

Embodiment 72. The pharmaceutical composition of embodiment 71, whereinthe angiotensin II receptor blocker is irbesartan, and dose of theirbesartan is about 49.5 mg.

Embodiment 73. The pharmaceutical composition of embodiment 71, whereinthe angiotensin II receptor blocker is telmisartan, and the dose of thetelmisartan is about 13.2 mg.

Embodiment 74. The pharmaceutical composition of embodiment 62, whereinthe angiotensin II receptor blocker is irbesartan, the diuretic ishydrochlorothiazide, and the calcium channel blocker is amlodipinebesylate.

Embodiment 75. The pharmaceutical composition of embodiment 74, whereinthe dose of irbesartan is from about 45 mg to about 60 mg, the dose ofhydrochlorothiazide is from about 7.5 mg to about 10 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg.

Embodiment 76. The pharmaceutical composition of embodiment 75, whereinthe dose of irbesartan is about 49.5 mg, the dose of hydrochlorothiazideis about 8.25 mg, and the dose of amlodipine besylate is about 1.65 mg.

Embodiment 77. The pharmaceutical composition of embodiment 62, whereinthe angiotensin II receptor blocker is telmisartan, the diuretic ishydrochlorothiazide, and the calcium channel blocker is amlodipinebesylate.

Embodiment 78. The pharmaceutical composition of embodiment 77, whereinthe dose of telmisartan is from about 12 mg to about 16 mg, the dose ofhydrochlorothiazide is from about 7.5 mg to about 10 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg.

Embodiment 79. The pharmaceutical composition of embodiment 78, whereinthe dose of telmisartan is about 13.2 mg, the dose ofhydrochlorothiazide is about 8.25 mg, and the dose of amlodipinebesylate is about 1.65 mg.

Embodiment 80. The pharmaceutical composition of embodiment 62, whereinthe angiotensin II receptor blocker is irbesartan, the diuretic isindapamide, and the calcium channel blocker is amlodipine besylate.

Embodiment 81. The pharmaceutical composition of embodiment 80, whereinthe dose of irbesartan is from about 45 mg to about 60 mg, the dose ofindapamide is from about 0.75 mg to about 1.0 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg.

Embodiment 82. The pharmaceutical composition of embodiment 81, whereinthe dose of irbesartan is about 49.5 mg, the dose of indapamide is about0.825 mg, and the dose of amlodipine is about 1.65 mg.

Embodiment 83. The pharmaceutical composition of embodiment 62, whereinthe angiotensin II receptor blocker is telmisartan, the diuretic isindapamide, and the calcium channel blocker is amlodipine besylate.

Embodiment 84. The pharmaceutical composition of embodiment 83, whereinthe dose of telmisartan is from about 12 mg to about 16 mg, the dose ofindapamide is from about 0.75 mg to about 1.0 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg.

Embodiment 85. The pharmaceutical composition of embodiment 84, whereinthe dose of telmisartan is about 13.2 mg, the dose of indapamide isabout 0.825 mg, and the dose of amlodipine besylate is about 1.65 mg.

Embodiment 86. The pharmaceutical composition of embodiment 62, whereinthe angiotensin II receptor blocker is telmisartan, the diuretic ischlorthalidone, and the calcium channel blocker is amlodipine besylate.

Embodiment 87. The pharmaceutical composition of embodiment 86, whereinthe dose of telmisartan is from about 12 mg to about 16 mg, the dose ofchlorthalidone is from about 15 mg to about 20 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg.

Embodiment 88. The pharmaceutical composition of embodiment 87, whereinthe dose of telmisartan is about 13.2 mg, the dose of chlorthalidone isabout 16.5 mg, and the dose of amlodipine besylate is about 1.65 mg.

Embodiment 89. The pharmaceutical composition of embodiment 62, whereinthe angiotensin II receptor blocker is irbesartan, the diuretic ischlorthalidone, and the calcium channel blocker is amlodipine besylate.

Embodiment 90. The pharmaceutical composition of embodiment 89, whereinthe dose of irbesartan is from about 45 mg to about 60 mg, the dose ofchlorthalidone is from about 15 mg to about 20 mg, and the dose ofamlodipine besylate is from about 1.5 mg to about 2 mg.

Embodiment 91. The pharmaceutical composition of embodiment 90, whereinthe dose of irbesartan is about 49.5 mg, the dose of chlorthalidone isabout 16.5 mg, and the dose of amlodipine besylate is about 1.65 mg.

Embodiment 92. The pharmaceutical composition of any one of embodiments1-91, wherein the dose of any one of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 80% to about 250% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker, the diuretic, orthe calcium channel blocker.

Embodiment 93. The pharmaceutical composition of embodiment 92, whereinthe dose of the angiotensin II receptor blocker is substituted with fromabout 80% to about 250% of the lowest hypertension therapeutic dose(LHTD) for the angiotensin II receptor blocker.

Embodiment 94. The pharmaceutical composition of embodiment 92, whereinthe dose of the diuretic is substituted with from about 80% to about250% of the lowest hypertension therapeutic dose (LHTD) for thediuretic.

Embodiment 95. The pharmaceutical composition of embodiment 92, whereinthe dose of the calcium channel blocker is substituted with from about80% to about 250% of the lowest hypertension therapeutic dose (LHTD) forthe calcium channel blocker.

Embodiment 96. The pharmaceutical composition of any one of embodiments92-95, wherein the dose of any one of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 80% to about 15% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker, the diuretic, orthe calcium channel blocker.

Embodiment 97. The pharmaceutical composition of embodiment 96, whereinthe dose of the angiotensin II receptor blocker is substituted with fromabout 80% to about 150% of the lowest hypertension therapeutic dose(LHTD) for the angiotensin II receptor blocker.

Embodiment 98. The pharmaceutical composition of embodiment 97, whereinthe dose of the angiotensin II receptor blocker is substituted withabout 100% of the lowest hypertension therapeutic dose (LHTD) for theangiotensin II receptor blocker.

Embodiment 99. The pharmaceutical composition of embodiment 96, whereinthe dose of the diuretic is substituted with from about 80% to about150% of the lowest hypertension therapeutic dose (LHTD) for thediuretic.

Embodiment 100. The pharmaceutical composition of embodiment 99, whereinthe dose of the diuretic is substituted with about 100% of the lowesthypertension therapeutic dose (LHTD) for the diuretic.

Embodiment 101. The pharmaceutical composition of embodiment 96, whereinthe dose of the calcium channel blocker is substituted with from about80% to about 150% of the lowest hypertension therapeutic dose (LHTD) forthe calcium channel blocker.

Embodiment 102. The pharmaceutical composition of embodiment 101,wherein the dose of the calcium channel blocker is substituted withabout 100% of the lowest hypertension therapeutic dose (LHTD) for thecalcium channel blocker.

Embodiment 103. The pharmaceutical composition of any one of embodiments92-95, wherein the dose of any one of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 150% to about 250% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker, thediuretic, or the calcium channel blocker.

Embodiment 104. The pharmaceutical composition of embodiment 103,wherein the dose of the angiotensin II receptor blocker is substitutedwith from about 150% to about 250% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker.

Embodiment 105. The pharmaceutical composition of embodiment 104,wherein the dose of the angiotensin II receptor blocker is substitutedwith about 200% of the lowest hypertension therapeutic dose (LHTD) forthe angiotensin II receptor blocker.

Embodiment 106. The pharmaceutical composition of embodiment 103,wherein the dose of the diuretic is substituted with from about 150% toabout 250% of the lowest hypertension therapeutic dose (LHTD) for thediuretic.

Embodiment 107. The pharmaceutical composition of embodiment 106,wherein the dose of the diuretic is substituted with about 200% of thelowest hypertension therapeutic dose (LHTD) for the diuretic.

Embodiment 108. The pharmaceutical composition of embodiment 103,wherein the dose of the calcium channel blocker is substituted with fromabout 150% to about 250% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker.

Embodiment 109. The pharmaceutical composition of any embodiment 108,wherein the dose of the calcium channel blocker is substituted withabout 200% of the lowest hypertension therapeutic dose (LHTD) for thecalcium channel blocker.

Embodiment 110. The pharmaceutical composition of any one of embodiments1-91, wherein the dose of any two of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 80% to about 250% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker, the diuretic, orthe calcium channel blocker.

Embodiment 111. The pharmaceutical composition of embodiment 110,wherein the dose of the angiotensin II receptor blocker is substitutedwith from about 80% to about 250% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker.

Embodiment 112. The pharmaceutical composition of embodiment 110,wherein the dose of the diuretic is substituted with from about 80% toabout 250% of the lowest hypertension therapeutic dose (LHTD) for thediuretic.

Embodiment 113. The pharmaceutical composition of embodiment 110,wherein the dose of the calcium channel blocker is substituted with fromabout 80% to about 250% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker.

Embodiment 114. The pharmaceutical composition of any one of embodiments110-113, wherein the dose of any two of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 80% to about 150% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker, the diuretic, orthe calcium channel blocker.

Embodiment 115. The pharmaceutical composition of embodiment 114,wherein the dose of the angiotensin II receptor blocker is substitutedwith from about 80% to about 150% of the lowest hypertension therapeuticdose (LHTD) for the angiotensin II receptor blocker.

Embodiment 116. The pharmaceutical composition of embodiment 115,wherein the dose of the angiotensin II receptor blocker is substitutedwith about 100% of the lowest hypertension therapeutic dose (LHTD) forthe angiotensin II receptor blocker.

Embodiment 117. The pharmaceutical composition of embodiment 114,wherein the dose of the diuretic is substituted with from about 80% toabout 150% of the lowest hypertension therapeutic dose (LHTD) for thediuretic.

Embodiment 118. The pharmaceutical composition of embodiment 117,wherein the dose of the diuretic is substituted with about 100% of thelowest hypertension therapeutic dose (LHTD) for the diuretic.

Embodiment 119. The pharmaceutical composition of embodiment 114,wherein the dose of the calcium channel blocker is substituted with fromabout 80% to about 150% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker.

Embodiment 120. The pharmaceutical composition of embodiment 119,wherein the dose of the calcium channel blocker is substituted withabout 100% of the lowest hypertension therapeutic dose (LHTD) for thecalcium channel blocker.

Embodiment 121. The pharmaceutical composition of any one of embodiments110-113, wherein the dose of any two of the angiotensin II receptorblocker, the diuretic, and the calcium channel blocker is substitutedwith from about 150% to about 250% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker, thediuretic, or the calcium channel blocker.

Embodiment 122. The pharmaceutical composition of embodiment 121,wherein the dose of the angiotensin II receptor blocker is substitutedwith from about 150% to about 250% of the lowest hypertensiontherapeutic dose (LHTD) for the angiotensin II receptor blocker.

Embodiment 123. The pharmaceutical composition of embodiment 122,wherein the dose of the angiotensin II receptor blocker is substitutedwith about 200% of the lowest hypertension therapeutic dose (LHTD) forthe angiotensin II receptor blocker.

Embodiment 124. The pharmaceutical composition of embodiment 121,wherein the dose of the diuretic is substituted with from about 150% toabout 250% of the lowest hypertension therapeutic dose (LHTD) for thediuretic.

Embodiment 125. The pharmaceutical composition of embodiment 124,wherein the dose of the diuretic is substituted with about 200% of thelowest hypertension therapeutic dose (LHTD) for the diuretic.

Embodiment 126. The pharmaceutical composition of embodiment 121,wherein the dose of the calcium channel blocker is substituted with fromabout 150% to about 250% of the lowest hypertension therapeutic dose(LHTD) for the calcium channel blocker.

Embodiment 127. The pharmaceutical composition of any embodiment 126,wherein the dose of the calcium channel blocker is substituted withabout 200% of the lowest hypertension therapeutic dose (LHTD) for thecalcium channel blocker.

Embodiment 128: A pharmaceutical composition comprising

-   -   (a) telmisartan;    -   (b) a thiazide-like diuretic; and    -   (c) a calcium channel blocker        wherein the dose of each (a), (b), and (c) is from about 80% to        about 150% of the lowest hypertension therapeutic dose (LHTD)        for each of the (a), (b), and (c).

Embodiment 129: The pharmaceutical composition of embodiment 128,wherein the pharmaceutical composition is essentially free of anangiotensin-converting enzyme inhibitor or a pharmaceutically acceptablesalt thereof, a beta-blocker or a pharmaceutically acceptable saltthereof, a lipid-regulating agent, platelet function-altering agent, aserum homocysteine-lowering agent, or a combination thereof.

Embodiment 130: The pharmaceutical composition of embodiments 128 or129, wherein the thiazide-like diuretic is quinethazone, clopamide,chlorthalidone, mefruside, clofenamide, metolazone, meticrane, xipamide,indapamide, clorexolone, fenquizone, or the pharmaceutically acceptablesalt or hydrate thereof.

Embodiment 131: The pharmaceutical composition of embodiment 130,wherein the thiazide-like diuretic is indapamide or the hydrate thereof.

Embodiment 132: The pharmaceutical composition of embodiment 131,wherein the thiazide-like diuretic is indapamide.

Embodiment 133: The pharmaceutical composition of any one of embodiments128-132, wherein the calcium channel blocker is amlodipine, nifedipine,diltiazem, nimodipine, verapamil, isradipine, felodipine, nicardipine,nisoldipine, clevidipine, dihydropyridine, lercanidipine, nitrendipine,cilnidipine, manidipine, mibefradil, bepridil, barnidipine, nilvadipine,gallopamil, lidoflazine, aranidipine, dotarizine, diproteverine, or thepharmaceutically acceptable salt or hydrate thereof.

Embodiment 134: The pharmaceutical composition of embodiment 133,wherein the calcium channel blocker is amlodipine or thepharmaceutically acceptable salt thereof.

Embodiment 135: The pharmaceutical composition of embodiment 134,wherein the calcium channel blocker is amlodipine besylate.

Embodiment 136: The pharmaceutical composition of any one of embodiments128-135, wherein the dose of each (a), (b), and (c) is from about 80% toabout 120% of the lowest hypertension therapeutic dose (LHTD) for eachof the (a), (b), and (c).

Embodiment 137: The pharmaceutical composition of embodiment 136,wherein the dose of the thiazide-like diuretic is about 100% of thelowest hypertension therapeutic dose (LHTD) for the thiazide-likediuretic.

Embodiment 138: The pharmaceutical composition of embodiment 137,wherein the thiazide-like diuretic is indapamide, and the dose of theindapamide is about 1.25 mg.

Embodiment 139: The pharmaceutical composition of any one of embodiments136-138, wherein the dose of the calcium channel blocker is about 100%of the lowest hypertension therapeutic dose (LHTD) for the calciumchannel blocker.

Embodiment 140: The pharmaceutical composition of embodiment 139,wherein the calcium channel blocker is amlodipine besylate, and the doseof amlodipine besylate is about 2.5 mg.

Embodiment 141: The pharmaceutical composition of any one of embodiments136-140, wherein the dose of the telmisartan is about 100% of the lowesthypertension therapeutic dose (LHTD) for telmisartan.

Embodiment 142: The pharmaceutical composition of embodiment 141,wherein the dose of the telmisartan is about 20 mg.

Embodiment 143: The pharmaceutical composition of embodiment 136,wherein the thiazide-like diuretic is indapamide, and the calciumchannel blocker is amlodipine besylate.

Embodiment 144: The pharmaceutical composition of embodiment 143,wherein the dose of telmisartan is from about 16 mg to about 24 mg, thedose of indapamide is from about 1 mg to about 1.5 mg, and the dose ofamlodipine besylate is from about 2 mg to about 3 mg.

Embodiment 145: The pharmaceutical composition of embodiment 143,wherein the dose of telmisartan is about 20 mg, the dose of indapamideis about 1.25 mg, and the dose of amlodipine besylate is about 2.5 mg.

Embodiment 146. The pharmaceutical composition of any one of embodiments1-145, wherein (a), (b), and (c) are provided in one formulation.

Embodiment 147. The pharmaceutical composition of any one of embodiments1-145, wherein (a), (b), and (c) are each provided in a separateformulation.

Embodiment 148. The pharmaceutical composition of any one of embodiments1-145, wherein two of the (a), (b), and (c) are provided in oneformulation.

Embodiment 149. The pharmaceutical composition of any one of embodiments1-148, wherein the pharmaceutical composition is in the form of pill,tablet, or capsule.

Embodiment 150. The pharmaceutical composition of any one of embodiments1-149, wherein the pharmaceutical composition is suitable for oraladministration.

Embodiment 151: A method of treating hypertension in a subject in needthereof comprising administering the pharmaceutical composition of anyone of embodiments 1-150.

Embodiment 152. The method of embodiment 151, wherein the treatmentresults in a systolic blood pressure (SBP) of less than about 140 mmHg.

Embodiment 153. The method of embodiments 150 or 151, wherein thetreatment results in a reduction of systolic blood pressure (SBP) ofabout 10 mmHg or greater.

Embodiment 154. The method of any one of embodiments 150-153, whereinthe treatment results in a diastolic blood pressure (DBP) of less thanabout 90 mmHg.

Embodiment 155. The method of any one of embodiments 150-154, whereinthe treatment results in a reduction of diastolic blood pressure (DBP)of about 5 mmHg or greater.

Embodiment 156. The method of any one of embodiments 150-155, whereintreatment results in a reduction in systolic blood pressure (SBP) thatis greater than the reduction obtained with the full lowest hypertensiontherapeutic dose of any one of the (a), (b), and (c) in thepharmaceutical composition.

Embodiment 157. The method of any one of embodiments 150-156, whereintreatment results in a reduction in diastolic blood pressure (DBP) thatis greater than the reduction obtained with the full lowest hypertensiontherapeutic dose of any one of (a), (b), and (c) in the pharmaceuticalcomposition.

Embodiment 158. The method of any one of embodiments 150-157, whereinthe treatment results in greater long term tolerability and reduced riskof side effects when compared to treatment with the full lowesthypertension therapeutic dose of any one of (a), (b), and (c) in thepharmaceutical composition.

Embodiment 159. The method of any one of embodiments 150-158, whereinthe treatment is the initial or first-line treatment of hypertension.

Embodiment 160. The method of any one of embodiments 150-159, whereinthe subject is not receiving any previous hypertension therapy prior totreatment.

While preferred embodiments of the present disclosure have been shownand described herein, it will be obvious to those skilled in the artthat such embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the disclosure. It should beunderstood that various alternatives to the embodiments of thedisclosure described herein may be employed in practicing thedisclosure. It is intended that the following claims define the scope ofthe disclosure and that methods and structures within the scope of theseclaims and their equivalents be covered thereby.

What is claimed is:
 1. A pharmaceutical composition comprising: (a)telmisartan; (b) hydrochlorothiazide; and (c) amlodipine besylate;wherein the dose of telmisartan is from about 8 mg to about 12 mg, thedose of hydrochlorothiazide is from about 5 mg to about 7.5 mg, and thedose of amlodipine besylate is from about 1 mg to about 1.5 mg; andwherein the pharmaceutical composition is free of beta-blocker.
 2. Thepharmaceutical composition of claim 1, wherein the dose ofhydrochlorothiazide is about 6.25 mg.
 3. The pharmaceutical compositionof claim 1, wherein the dose of amlodipine besylate is about 1.25 mg. 4.The pharmaceutical composition of claim 1, wherein the dose oftelmisartan is about 10 mg.
 5. The pharmaceutical composition of claim1, wherein the dose of hydrochlorothiazide is about 6.25 mg and the doseof amlodipine besylate is about 1.25 mg.
 6. The pharmaceuticalcomposition of claim 1, wherein the dose of hydrochlorothiazide is about6.25 mg and the dose of telmisartan is about 10 mg.
 7. Thepharmaceutical composition of claim 1, wherein the dose of amlodipinebesylate is about 1.25 mg and the dose of telmisartan is about 10 mg. 8.The pharmaceutical composition of claim 1, wherein the dose ofhydrochlorothiazide is about 6.25 mg, the dose of amlodipine besylate isabout 1.25 mg, and the dose of telmisartan is about 10 mg.
 9. A methodof treating hypertension in a subject in need thereof comprisingadministering to the subject the pharmaceutical composition of claim 1.10. The method of claim 9, wherein the treatment results in a systolicblood pressure (SBP) of less than about 140 mmHg, a reduction ofsystolic blood pressure (SBP) of about 10 mmHg or greater, a diastolicblood pressure (DBP) of less than about 90 mmHg, a reduction ofdiastolic blood pressure (DBP) of about 5 mmHg or greater orcombinations thereof.
 11. A pharmaceutical composition comprising: (a)telmisartan; (b) hydrochlorothiazide; and (c) amlodipine besylate;wherein a dose of telmisartan is about 16 mg to about 24 mg, a dose ofhydrochlorothiazide is about 10 mg to about 15 mg, and a dose ofamlodipine besylate is about 2 mg to about 3 mg; and wherein thepharmaceutical composition is free of a beta-blocker.
 12. Thepharmaceutical composition of claim 11, wherein the dose ofhydrochlorothiazide is about 12.5 mg.
 13. The pharmaceutical compositionof claim 11, wherein the dose of amlodipine besylate is about 2.5 mg.14. The pharmaceutical composition of claim 11, wherein the dose oftelmisartan is about 20 mg.
 15. The pharmaceutical composition of claim11, wherein the dose of hydrochlorothiazide is about 12.5 mg and thedose of amlodipine besylate is about 2.5 mg.
 16. The pharmaceuticalcomposition of claim 11, wherein the dose of hydrochlorothiazide isabout 12.5 mg and the dose of telmisartan is about 20 mg.
 17. Thepharmaceutical composition of claim 11, wherein the dose of amlodipinebesylate is about 2.5 mg and the dose of telmisartan is about 20 mg. 18.The pharmaceutical composition of claim 11, wherein the dose ofhydrochlorothiazide is about 12.5 mg, the dose of amlodipine besylate isabout 2.5 mg, and the dose of telmisartan is about 20 mg.
 19. A methodof treating hypertension in a subject in need thereof comprisingadministering to the subject the pharmaceutical composition of claim 11.20. The method of claim 19, wherein the treatment results in a systolicblood pressure (SBP) of less than about 140 mmHg, a reduction ofsystolic blood pressure (SBP) of about 10 mmHg or greater, a diastolicblood pressure (DBP) of less than about 90 mmHg, a reduction ofdiastolic blood pressure (DBP) of about 5 mmHg or greater orcombinations thereof.